Imperial College London

DrMaximilianJohnston

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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Contact

 

+44 (0)20 3312 1058m.johnston

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
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47 results found

Clement KD, Light A, Asif A, Chan VW-S, Khadhouri S, Shah TT, Banks F, Dorkin T, Driver CP, During V, Fraser N, Johnston MJ, Lucky M, Modgil V, Muneer A, Parnham A, Pearce I, Shabbir M, Shenoy M, Summerton DJ, Undre S, Williams A, MacLennan S, Kasivisvanathan Vet al., 2022, A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding Consensus for Orchidopexy in Torsion (FIX-IT) study, BJU INTERNATIONAL, ISSN: 1464-4096

Journal article

Beamish AJ, Johnston MJ, Harries RL, Mohan H, Fitzgerald JEF, Humm G, Rabie M, Nally DM, Gokani VJ, Ali O, Burke J, Clements JM, Cubas V, Fleming C, Giwa L, Glasbey J, Gokani VJ, Gonzi G, Harries R, Hughes K, Kane EG, MacLeod K, Manook M, Mohan H, Nally D, Pucher PH, Sahnan K, Shelton F, Srikandarajah N, Stovell M, Thaventhiran A, Walker NR, Wilkins Aet al., 2020, Use of the eLogbook in surgical training in the United Kingdom: A nationwide survey and consensus recommendations from the Association of Surgeons in Training, INTERNATIONAL JOURNAL OF SURGERY, Vol: 84, Pages: 199-206, ISSN: 1743-9191

Journal article

Beamish AJ, Johnston MJ, Harries RL, Mohan HM, Fitzgerald JEF, Humm G, Rabie M, Nally DM, Gokani VJ, Council of the Association of Surgeons in Traininget al., 2020, Real-world use of workplace based assessments in surgical training: A UK nationwide cross-sectional exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training., Int J Surg, Vol: 84, Pages: 212-218

BACKGROUND: Despite widespread uptake, the utility of Workplace Based Assessments (WBAs) is disputed and evidence underpinning their use is largely based upon their completion in ideal conditions, rather than the real-world setting. AIM: To ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. MATERIALS AND METHODS: An anonymous online questionnaire conducted nationally via the Association of Surgeons in Training (ASiT). Evaluation of 906 completed trainee responses, across all surgical specialties and training levels, employed mixed methods to interpret quantitative and qualitative data. RESULTS: The sample permitted a 3.0% confidence level with acceptable internal consistency (Cronbach's alpha 0.755). Formative use was supported by 72.5% and summative use was rejected by almost as many (66.3%). WBA use was perceived to deviate markedly from that recommended by the Joint Committee on Surgical Training (JCST). Significant misuse was identified and elements perceived as inaccurate appear commonplace across the breadth of surgical specialties. Inaccurate completion was acknowledged by 89.6% of respondents and some trainers appear complicit, 147 individuals (16.2%) having reported this to trainers, 40.9% aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers. Furthermore, a majority of trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Reasons for misuse appeared largely centred upon time restraints, lack of engagement and a will to achieve the required targets for career progression. 1.5 CONCLUSIONS: This study demonstrates that UK surgical trainees perceive that most trainees deviate from guidance in their use of WBAs. This is worrying in both the apparent frequency and nature of misuse and somewhat undermines existing evidence for their role in surgical training. Trainees perceive that

Journal article

Johnston MJ, Johnston TJ, Hanna L, 2020, Editorial Comment to Development and content validation of the percutaneous nephrolithotomy assessment score, INTERNATIONAL JOURNAL OF UROLOGY, Vol: 27, Pages: 965-965, ISSN: 0919-8172

Journal article

Johnston MJ, Noureldin M, Abdelmotagly Y, Paramore L, Gehring T, Nedas TG, Rajkumar G, Emara A, Hindley RGet al., 2020, Rezum water vapour therapy: promising early outcomes from the first UK series, BJU INTERNATIONAL, Vol: 126, Pages: 557-558, ISSN: 1464-4096

Journal article

Johnston MJ, Guillaumier S, Al Jaafari F, Hindley RGet al., 2020, The 'Urological Stethoscope': an essential aide for the modern benign prostatic hyperplasia specialist?, BJU INTERNATIONAL, Vol: 125, Pages: 632-633, ISSN: 1464-4096

Journal article

Johnston MJ, Thorman H, Shah A, Peppercorn D, Emara A, Scott K, Nedas TG, Hindley RGet al., 2019, Comparing significant prostate cancer detection rates after the introduction of pre-biopsy MRI: turning PROMIS into action, JOURNAL OF CLINICAL UROLOGY, Vol: 12, Pages: 341-346, ISSN: 2051-4158

Journal article

Archer SA, Pinto A, Vuik S, Bicknell C, Faiz O, Byrne B, Johnston M, Skapinakis P, Athanasiou T, Vincent C, Darzi Aet al., 2019, Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors, Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932

Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.

Journal article

Hassen YAM, Johnston MJ, Singh P, Pucher PH, Darzi Aet al., 2019, Key components of the safe surgical ward: international Delphi consensus study to identify factors for quality assessment and service improvement, Annals of Surgery, Vol: 269, Pages: 1064-1072, ISSN: 0003-4932

Objective: The aim of this study was to prioritize key factors contributing to safety on the surgical wardBackground: There is a variation in the quality and safety of postoperative care between institutions. These variations may be attributed to a combination of process-related issues and structural factors. The aim of this study is to reach a consensus, by means of Delphi methodology, on the most influential of these components that may determine safety in this environment. Methods: The Delphi questionnaire was delivered via an online questionnaire platform. The panel were blinded. An international panel of safety experts, both clinical and nonclinical, and safety advocates participated. Individuals were selected according to their expertise and extent of involvement in patient safety research, regulation, or patient advocacy. Results: Experts in patient safety from the UK, Europe, North America, and Australia participated. The panel identified the response to a deteriorating patient and the care of outlier patients as error-prone processes. Prioritized structural factors included organizational and environmental considerations such as use of temporary staff, out-of-hours reduction in services, ward cleanliness, and features of layout. The latter includes dedicated areas for medication preparation and adequate space around the patient for care delivery. Potential quality markers for safe care that achieved the highest consensus include leadership, visibility between patients and nurses, and nursing team skill mix and staffing levels. Conclusion: International consensus was achieved for a number of factors across process-related and structural themes that may influence safety in the postoperative environment. These should be championed and prioritized for future improvements in patient safety at the ward-level.

Journal article

Johnston MJ, Nigam R, 2019, Recent advances in the management of penile cancer [version 1; peer review: 2 approved], F1000Research, Vol: 8, ISSN: 2046-1402

Penile cancer is a rare condition and can be very complex to manage. Advances in surgical techniques, imaging, pathological classification and patient pathways have led to improved patient care. The diagnosis of pre-malignant change, penile cancer and metastatic disease along with advances in their treatment are detailed in this review which aims to update clinicians from multiple specialties and countries on penile cancer.

Journal article

Pucher P, Johnston M, Archer S, Whitby J, Dawson P, Arora S, Darzi Aet al., 2019, Informing the consent process for surgeons: A survey study of patient preferences, perceptions and risk tolerance, Journal of Surgical Research, Vol: 235, Pages: 298-302, ISSN: 0022-4804

BackgroundDespite the ethical and statutory requirement to obtain consent for surgical procedures, the actual process itself is less well defined. The degree of disclosure and detail expected may vary greatly. A recent shift toward a more patient-centered approach in both clinical and medico-legal practice has significant implications for ensuring appropriate and legal practice in obtaining informed consent before surgery.MethodsTwo hundred patients undergoing elective surgery across two hospitals returned a survey of attitudes toward consent, perceived important elements in the consent process, and risk tolerance, as well as demographic details.ResultsNo significant associations between patient demographics and survey responses were found. Patients were least concerned with the environment in which consent was taken and the disclosure of uncommon complications. The most important factors related to communication and rapport between clinician and patients, as opposed to procedure- or complication-specific items. A majority of patients preferred risks to be described using proportional descriptors, rather than percentage or non-numeric descriptors.ConclusionsRisk tolerance and desired level of disclosure varies for each patient and should not be presumed to be covered by standardized proformas. We suggest an individualized approach, taking into account each patient's background, understanding, and needs, is crucial for consent. Communications skills must be prioritized to ensure patient satisfaction and reduced risk of litigation.

Journal article

Hassen Y, Singh P, Pucher PH, Johnston MJ, Darzi Aet al., 2018, Identifying quality markers of a safe surgical ward: an interview study of patients, clinical staff, and administrators, Surgery, Vol: 163, Pages: 1226-1233, ISSN: 0039-6060

BACKGROUND: Postoperative care quality is variable. Risk-adjusted mortality rates differ between institutions despite comparable complication rates. This indicates that there are underlying factors rooted in how care is delivered that determines patient safety. This study aims to evaluate systematically the surgical ward environment with respect to process-driven and structural factors to identify quality markers for safe care, from which new safety metrics may be derived. METHODS: Semistructured interviews of clinicians, nurses, patients and administrators were undertaken for the study. RESULTS: In the study, 97% of staff members recognized the existence of variation in patient safety between surgical wards. Four main error-prone processes were identified: ward rounds (57%), medication prescribing and administration (49%), the presence of outliers (43%), and deficiencies in communication between clinical staff (43%). Structural factors were categorized as organizational or environmental; organizational included shortage in staffing (39%) and use of temporary staff (27%). Environmental factors considered layout and patient visibility to nurses (49%) as well as cleanliness (29%). Safety indicators identified included staff experience level (31%), overall layout of the ward, cleanliness and leadership (all 27% each). The majority of patients (87%) identified staff attentiveness as a safety indicator. CONCLUSION: This study demonstrates that there are a number of factors that may contribute to safety on the surgical ward spanning multiple processes, organizational, and environmental factors. Safety indicators identified across all these categories presents an opportunity to develop broader and more effectual safety improvement measures focusing on multiple areas simultaneously.

Journal article

Lee MJ, National Research Collaborative, Association of Surgeons in Training Collaborative Consensus Group, Shalhoub Jet al., 2018, Recognising contributions to work in research collaboratives: Guidelines for standardising reporting of authorship in collaborative research, International Journal of Surgery, Vol: 52, Pages: 355-360, ISSN: 1743-9191

BackgroundTrainee research collaboratives (TRCs) have been revolutionary changes to the delivery of high-quality, multicentre research. The aim of this study was to define common roles in the conduct of collaborative research, and map these to academic competencies as set out by General Medical Council (GMC) in the United Kingdom. This will support trainers and assessors when judging academic achievements of those involved in TRC projects, and supports trainees by providing guidance on how to fulfil their role in these studies.MethodsA modified Delphi process was followed. Electronic discussion with key stakeholders was undertaken to identify and describe common roles. These were refined and mapped to GMC educational domains and International Committee of Medical Journal Editors authorship (ICJME) guidelines. The resulting roles and descriptions were presented to a face-to-face consensus meeting for voting. The agreed roles were then presented back to the electronic discussion group for approval.ResultsElectronic discussion generated six common roles. All of these were agreed in face-to-face meetings, where two further roles identified and described. All eight roles required skills that map to part of the academic requirements for surgical training in the UK.DiscussionThis paper presents a standardised framework for reporting authorship in collaborative group authored research publications. Linkage of collaborator roles to the ICMJE guidelines and GMC academic competency guidelines will facilitate incorporation into relevant training curricular and journal publication policies.

Journal article

Parand A, Faiella G, Franklin BD, Johnston M, Clemente F, Stanton NA, Sevdalis Net al., 2018, A prospective risk assessment of informal carers' medication administration errors within the domiciliary setting, ERGONOMICS, Vol: 61, Pages: 104-121, ISSN: 0014-0139

Journal article

Johnston MJ, Arora S, Darzi A, 2017, Reply to Letter: "Improving Escalation of Care: Development and Validation of the Quality of Information Transfer Tool"., Annals of Surgery, Vol: 266, Pages: e114-e115, ISSN: 0003-4932

Journal article

McGlynn B, Johnston M, Green J, 2017, A nurse-led multidisciplinary team approach in urology-oncology: Addressing the new cancer strategy, JOURNAL OF CLINICAL UROLOGY, Vol: 10, Pages: 449-456, ISSN: 2051-4158

Journal article

Hosny SG, Johnston MJ, Pucher PH, Erridge S, Darzi Aet al., 2017, Barriers to the implementation and uptake of simulation-based training programs in general surgery: a multinational qualitative study., Journal of Surgical Research, Vol: 220, Pages: 419-426.e2, ISSN: 0022-4804

BACKGROUND: Despite evidence demonstrating the advantages of simulation training in general surgery, it is not widely integrated into surgical training programs worldwide. The aim of this study was to identify barriers and facilitators to the implementation and uptake of surgical simulation training programs. METHODS: A multinational qualitative study was conducted using semi-structured interviews of general surgical residents and experts. Each interview was audio recorded, transcribed verbatim, and underwent emergent theme analysis. All data were anonymized and results pooled. RESULTS: A total of 37 individuals participated in the study. Seventeen experts (Program Directors and Surgical Attendings with an interest in surgical education) and 20 residents drawn from the United States, Canada, United Kingdom, France, and Japan were interviewed. Barriers to simulation-based training were identified based on key themes including financial cost, access, and translational benefit. Participants described cost (89%) and access (76%) as principal barriers to uptake. Common facilitators included a mandatory requirement to complete simulation training (78%) and on-going assessment of skills (78%). Participants felt that simulation training could improve patient outcomes (76%) but identified a lack of evidence to demonstrate benefit (38%). There was a consensus that simulation training has not been widely implemented (70%). CONCLUSIONS: There are multiple barriers to the implementation of surgical simulation training programs, however, there is agreement that these programs could potentially improve patient outcomes. Identifying these barriers enable the targeted use of facilitators to deliver simulation training programs.

Journal article

Johnston MJ, Arora S, Darzi A, 2017, Response to "RE: Escalation of Care in Surgery: A Systematic Risk Assessment to Prevent Avoidable Harm in Hospitalized Patients'', ANNALS OF SURGERY, Vol: 266, Pages: E28-E28, ISSN: 0003-4932

Journal article

Johnston MJ, Arora S, Darzi A, 2017, Reply to "RE: Escalation of Care in Surgery: A Systematic Risk Assessment to Prevent Avoidable Harm in Hospitalized Patients.", Annals of Surgery, Vol: 266, Pages: e28-e28, ISSN: 0003-4932

Journal article

Pannick SAJ, Archer S, Johnston MJ, Beveridge I, Long SJ, Athanasiou T, Sevdalis Net al., 2017, Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards, BMJ Open, Vol: 7, ISSN: 2044-6055

ObjectivesTo understand how frontline reports of day-to-day care failings might be better translated into improvement.DesignQualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS.ResultsPCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described.ConclusionsProspective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are

Journal article

Hassen Y, Johnston M, Barrow EJ, Darzi Aet al., 2017, Safety and the Use of Checklists in Acute Care Surgery, Acute Care Surgery Handbook Volume 1 General Aspects, Non-gastrointestinaI and Critical Care Emergencies, Publisher: Springer, ISBN: 9783319153407

This pocket manual is a practically oriented, wide-ranging guide to acute care surgery general aspects and to non-gastrointestinal emergencies.

Book chapter

Johnston MJ, Arora S, King D, Darzi Aet al., 2016, Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle., Annals of Surgery, Vol: 267, Pages: 73-80, ISSN: 0003-4932

Objective: This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital.Summary of Background Data: Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety.Methods: A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards. Twenty-seven junior and senior surgeons completed validated questionnaires assessing supervision, escalation of care, and safety culture pre and post-intervention along with interviews to further explore the impact of the intervention. Patient outcomes pre and postintervention were also analyzed.Results: Questionnaires revealed significant improvements in supervision postintervention (senior median pre 5 vs post 7, P = 0.002 and junior 4 vs 6, P = 0.039) and senior surgeon approachability (junior 5 vs 6, P = 0.047). Both groups agreed that they would feel safer as a patient in their hospital postintervention (senior 3 vs 4.5, P = 0.021 and junior 3 vs 4, P = 0.034). The interviews confirmed that the safety culture of the department had improved. There were no differences in inpatient mortality, cardiac arrest, reoperation, or readmission rates pre and postintervention.Conclusion: Improving supervision and introducing clear protocols can improve safety culture on the surgical ward. Future work should evaluate the effect these measures have on patient outcomes in multiple institutions.

Journal article

Bagnall NM, Pucher PH, Johnston MJ, Arora S, Athanasiou T, Faiz O, Darzi LAet al., 2016, Informing the process of consent for surgery: identification of key constructs and quality factors, Journal of Surgical Research, Vol: 209, Pages: 86-92, ISSN: 0022-4804

BackgroundInformed consent is a fundamental requirement of any invasive procedure. Failure to obtain appropriate and informed consent may result in unwanted or unnecessary procedures, as well as financial penalty in case of litigation. The aim of this study was to identify key constructs of the consent process which might be used to determine the performance of clinicians taking informed consent in surgery.MethodsA multimodal methodology was used. A systematic review was conducted in accordance with PRISMA guidelines to identify evidence-based components of the consent process. Results were supplemented by semistructured interviews with senior trainees and attending surgeons which were transcribed and subjected to emergent theme analysis with repeated sampling until thematic saturation was reached.ResultsA total of 710 search results were returned, with 26 articles included in the final qualitative synthesis of the systematic review. Significant variation existed between articles in the description of the consent procedure. Sixteen semistructured interviews were conducted before saturation was reached. Key components of the consent process were identified with broad consensus for the most common elements. Trainers felt that experiential learning and targeted skills training courses should be used to improve practice in this area.ConclusionsKey components for obtaining informed consent in surgery have been identified. These should be used to influence curricular design, possible assessment methods, and focus points to improve clinical practice and patient experience in future.

Journal article

Hassen YAM, Singh P, Pucher PH, Johnston MJ, Darzi AWet al., 2016, Identifying Quality Markers of a Safe Surgical Ward: An Interview Study of Patients, Clinical Staff and Administrators, Journal of The American College of Surgeons, Vol: 223, Pages: S109-S110, ISSN: 1072-7515

Journal article

Patel B, Johnston M, Cookson N, King D, Arora S, Darzi Aet al., 2016, Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 18, ISSN: 1438-8871

Background: Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication.Objective: The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers.Methods: We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users’ satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses.Results: We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100–121 versus pager median 77, range 39–104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included “enhances interprofessional efficiency,” “results in less disturbance,” “performed desired functions reliably,” and “allows me to clearly transfer information.”Conclusions: Hark

Journal article

Johnston MJ, Arora S, Pucher PH, McCartan N, Reissis Y, Chana P, Darzi Aet al., 2016, Improving Escalation of Care A Double-blinded Randomized Controlled Trial, ANNALS OF SURGERY, Vol: 263, Pages: 421-426, ISSN: 0003-4932

Objective: This study aimed to determine whether an intervention could improve the escalation of care skills of junior surgeons.Summary Background Data: Escalation of care involves the recognition, communication, and response to patient deterioration until a satisfactory outcome has been achieved. Although failure to escalate care can lead to increased morbidity and mortality, there is no formal training in how to perform this vital process safely.Methods: This randomized controlled trial recruited postgraduate year (PGY)-1 and PGY-2 surgeons to participate in 2 scenarios involving simulated patients requiring escalation of care. A control group performed both scenarios before receiving the intervention; the intervention group received the educational intervention before their second scenario. Scenarios were video recorded and rated by 2 independent, blinded assessors using validated scales to measure patient assessment, communication, management and nontechnical skills of participants, and the number of medical errors they detected.Results: A total of 33 PGY-1 and PGY-2 surgeons, all with equivalent skill at baseline, participated. Postintervention, the intervention group demonstrated significantly better patient assessment (P < 0.001), communication (P < 0.001), and nontechnical skills (P < 0.001). They also detected more medical errors (P < 0.05).Conclusions: Teaching junior surgeons a systematic approach to escalation of care improved multiple core skills required to maintain patient safety and avoid preventable harm.

Journal article

Johnston MJ, Arora S, Pucher PH, Reissis Y, Hull L, Huddy JR, King D, Darzi Aet al., 2016, Improving Escalation of Care Development and Validation of the Quality of Information Transfer Tool, ANNALS OF SURGERY, Vol: 263, Pages: 477-486, ISSN: 0003-4932

Objective: To develop and provide validity and feasibility evidence for the QUality of Information Transfer (QUIT) tool.Background: Prompt escalation of care in the setting of patient deterioration can prevent further harm. Escalation and information transfer skills are not currently measured in surgery.Methods: This study comprised 3 phases: the development (phase 1), validation (phase 2), and feasibility analysis (phase 3) of the QUIT tool. Phase 1 involved identification of core skills needed for successful escalation of care through literature review and 33 semistructured interviews with stakeholders. Phase 2 involved the generation of validity evidence for the tool using a simulated setting. Thirty surgeons assessed a deteriorating postoperative patient in a simulated ward and escalated their care to a senior colleague. The face and content validity were assessed using a survey. Construct and concurrent validity of the tool were determined by comparing performance scores using the QUIT tool with those measured using the Situation-Background-Assessment-Recommendation (SBAR) tool. Phase 3 was conducted using direct observation of escalation scenarios on surgical wards in 2 hospitals.Results: A 7-category assessment tool was developed from phase 1 consisting of 24 items. Twenty-one of 24 items had excellent content validity (content validity index >0.8). All 7 categories and 18 of 24 (P < 0.05) items demonstrated construct validity. The correlation between the QUIT and SBAR tools used was strong indicating concurrent validity (r = 0.694, P < 0.001). Real-time scoring of escalation referrals was feasible and indicated that doctors currently have better information transfer skills than nurses when faced with a deteriorating patient.Conclusions: A validated tool to assess information transfer for deteriorating surgical patients was developed and tested using simulation and real-time clinical scenarios. It may improve the quality and safety of patient care on

Journal article

Hosny S, Johnston M, Pucher P, Erridge S, Darzi Aet al., 2016, Modern paradigms in surgical training – An international qualitative study to determine factors affecting the implementation of simulation-based training programmes, American College of Surgeons Annual Meeting of the Consortium of Accredited Education Institutes in Chicago, 2016

Conference paper

Hosny S, Johnston M, Pucher P, Erridge S, Darzi Aet al., 2016, Modern paradigms in surgical training – An international qualitative study to determine factors affecting the implementation of simulation-based training programmes, ASiT 2016

Conference paper

Johnston M, King D, Darzi A, 2016, Reply to the letter: WhatsApp with patient data transmitted via instant messaging?, American Journal of Surgery, Vol: 211, Pages: 301-302, ISSN: 0002-9610

Journal article

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