Publications
48 results found
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
Mobasheri MH, Johnston M, Syed UM, et al., 2015, The uses of smartphones and tablet devices in surgery: A systematic review of the literature, SURGERY, Vol: 158, Pages: 1352-1371, ISSN: 0039-6060
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- Citations: 48
Mobasheri MH, King D, Johnston M, et al., 2015, The ownership and clinical use of smartphones by doctors and nurses in the UK: A multicentre survey study, BMJ Innovations, Vol: 1, Pages: 174-181, ISSN: 2055-8074
Background Much interest has arisen around the use of smartphones, tablet devices and related apps in the healthcare context. It has been suggested that increasing numbers of healthcare professionals are using these technologies in the workplace. We have performed an up-to-date UK-based, multicentre, cross-sectional survey study exploring the ownership rates and uses of these technologies among doctors and nurses, specifically focusing on the clinical environment. Methods After initial piloting, all doctors (n=2107) and nurses (n=4069) at 5 hospital sites were invited to complete a 36-item (nurses) or 38-item (doctors) survey. Exploratory descriptive statistics were calculated and the χ2 test was used to compare differences in categorical data between groups. Statistical significance was taken at a level of p<0.05. Results 98.9% of doctors and 95.1% of nurses owned a smartphone, while 73.5% and 64.7% owned a tablet device, respectively. Also, 92.6% of the doctors and 53.2% of nurses found their smartphone to be ‘very useful’ or ‘useful’ in helping them to perform their clinical duties, while 89.6% of doctors and 67.1% of nurses owning medical apps were using these as part of their clinical practice. Doctors and nurses were using short-message-script messaging (64.7% and 13.8%, respectively), app-based messaging (33.1% and 5.7%), and picture messaging (46.0% and 7.4%) (p=0.0001 for all modalities) to send patient-related clinical information to their colleagues. Therefore, 71.6% of doctors and 37.2% of nurses wanted a secure means of sending such information. Conclusions Compared to earlier studies, we have demonstrated much higher smartphone ownership among doctors and nurses, who perceive these devices to be useful when performing their clinical duties. Large numbers of staff are sending patient related clinical information using smartphone messaging modalities. Care must be taken by doctors and nurses to ensure that no identifiable p
Johnston MJ, Paige JT, Aggarwal R, et al., 2015, An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains, American Journal of Surgery, Vol: 211, Pages: 214-225, ISSN: 0002-9610
BackgroundKey research priorities for surgical simulation have been identified in recent years. The aim of this study was to establish the progress that has been made within each research priority and what still remains to be achieved.MethodsMembers of the Association for Surgical Education Simulation Committee conducted individualized literature reviews for each research priority that were brought together by an expert panel.ResultsExcellent progress has been made in the assessment of individual and teamwork skills in simulation. The best methods of feedback and debriefing have not yet been established. Progress in answering more complex questions related to competence and transfer of training is slower than other questions. A link between simulation training and patient outcomes remains elusive.ConclusionsProgress has been made in skills assessment, curricula development, debriefing and decision making in surgery. The impact of simulation training on patient outcomes represents the focus of simulation research in the years to come.
Pucher PH, Johnston MJ, Aggarwal R, et al., 2015, Effectiveness of interventions to improve patient handover in surgery: a systematic review, Surgery, Vol: 158, Pages: 85-95, ISSN: 0039-6060
Background:Handover of patient care is a critical process in the transfer of information between clinical teams and clinicians during transitions in patient care. The handover process may take many forms and is often unstructured and unstandardized, potentially resulting in error and the potential for patient harm. The Joint Commission has implicated such errors in up to 80% of sentinel events and has published guidelines (using an acronym termed SHARE) for the development of intervention tools for handover. This study aims to review interventions to improve handovers in surgery and to assess compliance of described methodologies with the guidelines of the Joint Commission for design and implementation of handover improvement tools.Methods:A systematic review was conducted in line with MOOSE guidelines. Electronic databases Medline, EMBASE, and PsyInfo were searched and interventions to improve surgical handover identified. Intervention types, development methods, and outcomes were compared between studies and assessed against SHARE criteria.Results:Nineteen studies were included. These studies included paper and computerized checklists, proformas, and/or standardized operating protocols for handover. All reported some degree of improvement in handover. Description of development methods, staff training, and follow-up outcome data was poor. Only a single study was able to demonstrate compliance with all 5 domains guidelines of the of Joint Commission.Conclusion:Improvements in information transfer may be achieved through checklist- or proforma-based interventions in surgical handover. Although initial data appear promising, future research must be backed by robust study design, relevant outcomes, and clinical implementation strategies to identify the most effective means to improve information transfer and optimize patient outcomes.
Johnston MJ, Singh P, Pucher PH, et al., 2015, Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes, BRITISH JOURNAL OF SURGERY, Vol: 102, Pages: 1156-1166, ISSN: 0007-1323
BackgroundThe number of surgeons entering fellowship training before independent practice is increasing. This may have a negative impact on surgeons in training. The impact of fellowship training on patient outcomes is not yet known. This review aimed to investigate the impact of fellowship training in surgery on patient outcomes.MethodsA systematic review of the literature was conducted to identify studies exploring the structural and surgeon‐specific characteristics of fellowship training on patient outcomes. Data from these studies were extracted, synthesized and reported qualitatively, or quantitatively through meta‐analysis.ResultsTwenty‐three studies were included. The mortality rate for patients in centres with an affiliated fellowship programme was lower than that for centres without (odds ratio 0·86, 95 per cent c.i. 0·84 to 0·88), as was the rate of complications (odds ratio 0·90, 0·78 to 1·02). Surgeons without fellowship training converted more laparoscopic operations to open surgery than those with fellowship training (risk ratio (RR) 1·04, 95 per cent c.i. 1·03 to 1·05). Comparison of outcomes for senior surgeons versus current fellows showed no differences in rates of mortality (RR 1·00, 1·00 to 1·01), complications (RR 1·03, 0·98 to 1·08) or conversion to open surgery (RR 1·01, 1·00 to 1·01).ConclusionFellowship training appears to have a positive impact on patient outcomes.
Johnston MJ, Davis RE, Arora S, et al., 2015, Raising the Alarm: A Cross-Sectional Study Exploring the Factors Affecting Patients' Willingness to Escalate Care on Surgical Wards, WORLD JOURNAL OF SURGERY, Vol: 39, Pages: 2207-2213, ISSN: 0364-2313
BackgroundDelays in escalation of care for patients may contribute to poor outcome. The factors that influence surgical patients’ willingness to call for help on wards are currently unknown. This study explored the factors that affect patients’ willingness to call for help on surgical wards; how patients call for help and to whom; how to encourage patients to call for help, and the barriers to patients calling for help.MethodsA cross-sectional study was conducted in three London hospitals using a questionnaire designed through expert opinion and the published literature. A total of 155 surgical patients (83 % response rate) participated.ResultsPatients were more willing to call for help using the bedside buzzer or by calling a nurse compared to a doctor (p < 0.001). The prompts to calling for help patients were most likely to act on were bleeding and pain. Patients were more willing to call for help if encouraged by a healthcare professional than a relative or fellow patient (p < 0.01). Patients were more likely to worry about taking up too much time when calling for help than being perceived as difficult (p < 0.001). For some prompts, male patients were more willing to call for help (p < 0.05).ConclusionsThis is the first study to identify factors affecting patients’ willingness to call for help on surgical wards. Interventions that take these factors into account can be developed to encourage patients to call for help and may avoid delays in treatment.
Johnston M, Arora S, Anderson O, et al., 2015, Escalation of care in surgery: a systematic risk assessment to prevent avoidable harm in hospitalized patients, Annals of Surgery, Vol: 261, Pages: 831-838, ISSN: 0003-4932
Objective: To systematically risk assess and analyze the escalation of care process in surgery so as to identify problems and provide recommendations for intervention.Background: The ability to escalate care appropriately when managing deteriorating patients is a hallmark of surgical competence and safe postoperative care. Healthcare-Failure-Mode-Effects-Analysis (HFMEA) is a methodology adapted from safety-critical industries, which allows for hazardous process failures to be prospectively identified and solutions to be recommended.Methods: Forty-two hours of ethnographic observations on surgical wards in 3 London hospitals (phase 1) formed the basis of an escalation process diagram. A risk-assessment survey identified failures associated with process steps and attributed hazard scores (phase 2). Patient safety and clinical risk experts validated hazard scores through a group consensus meeting (phase 3). Hazardous failures were taken forward to multidisciplinary HFMEA where cause analysis was applied and interventions were recommended (phase 4).Results: Observations identified 33 steps in the escalation process. The risk-assessment survey (30 surgical staff members, 100% response) and expert consensus group identified 18 hazardous failures associated with these steps. The HFMEA team identified 3 adequately controlled failures; therefore, 15 were subjected to cause analysis. Outdated communication technology, understaffing, and hierarchical barriers were identified as root causes of failure. Participants recommended interventions based on these findings including defined escalation protocols, human factors education, enhanced communication technology, and improved clinical supervision.Conclusions: Failures in the escalation process amenable to intervention were systematically identified. This mapping of the escalation process will allow tailored interventions to enhance surgical training and patient safety.
Johnston MJ, Arora S, King D, et al., 2015, A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery, Surgery, Vol: 157, Pages: 752-763, ISSN: 0039-6060
BackgroundThe relationship between the ability to recognize and respond to patient deterioration (escalate care) and its role in preventing failure to rescue (FTR; mortality after a surgical complication) has not been explored. The aim of this systematic review was to determine the incidence of, and factors contributing to, FTR and delayed escalation of care for surgical patients.MethodsA search of MEDLINE, EMBASE PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials was conducted to identify articles exploring FTR, escalation of care, and interventions that influence outcomes. Screening of 19,887 citations led to inclusion of 42 articles.ResultsThe reported incidence of FTR varied between 8.0 and 16.9%. FTR was inversely related to hospital volume and nurse staffing levels. Delayed escalation occurred in 20.7–47.1% of patients and was associated with greater mortality rates in 4 studies (P < .05). Causes of delayed escalation included hierarchy and failures in communication. Of five interventional studies, two reported a significant decrease in intensive care admissions (P < .01) after introduction of escalation protocols; only 1 study reported an improvement in mortality.ConclusionThis systematic review explored factors linking FTR and escalation of care in surgery. Important factors that contribute to the avoidance of preventable harm include the recognition and communication of serious deterioration to implement definitive treatment. Targeted interventions aiming to improve these factors may contribute to enhanced patient outcome.
Johnston M, Mobasheri M, King D, et al., 2015, The Imperial Clarify, Design and Evaluate (CDE) approach to mHealth app development, BMJ Innovations, Vol: 1, Pages: 39-42, ISSN: 2055-8074
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- Citations: 13
Johnston MJ, King D, Arora S, et al., 2015, Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams, American Journal of Surgery, Vol: 209, Pages: 45-51, ISSN: 0002-9610
BackgroundOutdated communication technologies in healthcare can place patient safety at risk. This study aimed to evaluate implementation of the WhatsApp messaging service within emergency surgical teams.MethodsA prospective mixed-methods study was conducted in a London hospital. All emergency surgery team members (n = 40) used WhatsApp for communication for 19 weeks. The initiator and receiver of communication were compared for response times and communication types. Safety events were reported using direct quotations.ResultsMore than 1,100 hours of communication pertaining to 636 patients were recorded, generating 1,495 communication events. The attending initiated the most instruction-giving communication, whereas interns asked the most clinical questions (P < .001). The resident was the speediest responder to communication compared to the intern and attending (P < .001). The participants felt that WhatsApp helped flatten the hierarchy within the team.ConclusionsWhatsApp represents a safe, efficient communication technology. This study lays the foundations for quality improvement innovations delivered over smartphones.
Johnston MJ, Muirhead LJ, Huddy JR, et al., 2015, Chlorhexidine-Induced Anaphylaxis During Surgery - Two Cases and Systematic Literature Review, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 281-281, ISSN: 0007-1323
Mobasheri MH, Johnston M, King D, et al., 2014, Smartphone breast applications - What's the evidence?, BREAST, Vol: 23, Pages: 683-689, ISSN: 0960-9776
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- Citations: 83
Chana P, Johnston MJ, Pullyblank AM, et al., 2014, Identifying Organizational Failures in Emergency General Surgical Admissions in the United Kingdom: A Healthcare Failure Mode Effect Analysis, Annual Clinical Congress of the American-College-of-Surgeons, Publisher: ELSEVIER SCIENCE INC, Pages: S92-S92, ISSN: 1072-7515
Johnston MJ, King D, Arora S, et al., 2014, Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis, Journal of Evaluation in Clinical Practice, Vol: 20, Pages: 486-497, ISSN: 1356-1294
Rationale, aims and objectivesIn order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user‐informed guide for the development of an application‐based communication system (ABCS), tailored for use in patient handover and escalation of care.MethodsCurrent methods of inter‐professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis.ResultsSeventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group‐messaging functions.ConclusionDespite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.
Johnston M, Arora S, King D, et al., 2014, Escalation of care and failure to rescue: a multicenter, multiprofessional qualitative study, Surgery, Vol: 155, Pages: 989-994, ISSN: 0039-6060
BackgroundThe escalation of care process has not been explored in surgery, despite the role of communication failures in adverse events. This study aimed to develop a conceptual framework of the influences on escalation of care in surgery allowing solutions to facilitate management of sick patients to be developed.MethodsA multicenter qualitative study was conducted in three hospitals in London, UK. A total of 41 participants were recruited, including 16 surgeons, 11 surgical PGY1s, six surgical nurses, four intensivists, and four critical care outreach team members. Participants were submitted to semistructured interviews that were analyzed using grounded theory methodology.ResultsA decision to escalate was based upon five key themes: patient, individual, team, environmental, and organizational factors. Most participants felt that supervision and escalation of care were problematic in their hospital, with unclear escalation protocols and poor availability of senior surgical staff the most common concerns. Mobile phones and direct conversation were identified to be more effective when escalating care than hospital pager systems. Transparent escalation protocols, increased senior clinician supervision, and communication skills training were highlighted as strategies to improve escalation of care.ConclusionThis is the first study to describe escalation of care in surgery, a key process for protecting the safety of deteriorating surgical patients. Factors affecting the decision to escalate are complex, involving clinical and professional aspects of care. An understanding of this process could pave the way for interventions to facilitate escalation in order to improve patient outcome.
Johnston MJ, Fitzgerald JEF, Bhangu A, et al., 2014, Outpatient management of biliary colic: A prospective observational study of prescribing habits and analgesia effectiveness, INTERNATIONAL JOURNAL OF SURGERY, Vol: 12, Pages: 169-176, ISSN: 1743-9191
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- Citations: 6
Johnston MJ, Prew CL, Fraser I, 2013, An unusual case of pancreatic fistula., J Surg Case Rep, Vol: 2013, ISSN: 2042-8812
We report an unusual case of a pancreatic fistula communicating with an appendicectomy wound. This occurred following an episode of acute haemorrhagic pancreatitis. The patient was initially admitted with signs and symptoms indicating appendicitis and went to theatre for an open appendicectomy. However, this did not resolve his symptoms and a laparotomy was performed the next day revealing haemorrhagic pancreatitis. He endured a stormy post-operative course, the cause of which was found to be an external pancreatic fistula with discharge of amylase-rich fluid from the Lanz incision. A trial of conservative management failed despite multiple percutaneous drainage procedures and treatment with broad-spectrum antibiotics. After a second opinion was sought, it was decided to fit a roux loop anastomosis between the head of the pancreas and the duodenum to divert the fistulous fluid. This procedure was a success and the patient remains well 2 years later.
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