46 results found
Weigl M, Mueller A, Holland S, et al., 2016, Work conditions, mental workload and patient care quality: a multisource study in the emergency department, BMJ QUALITY & SAFETY, Vol: 25, Pages: 499-508, ISSN: 2044-5415
Flowerdew L, Gaunt A, Spedding J, et al., 2013, A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills, EMERGENCY MEDICINE JOURNAL, Vol: 30, Pages: 437-443, ISSN: 1472-0205
Farhan M, Brown R, Woloshynowych M, et al., 2012, The ABC of handover: a qualitative study to develop a new tool for handover in the emergency department, EMERGENCY MEDICINE JOURNAL, Vol: 29, Pages: 941-946, ISSN: 1472-0205
Farhan M, Brown R, Vincent C, et al., 2012, The ABC of handover: impact on shift handover in the emergency department, EMERGENCY MEDICINE JOURNAL, Vol: 29, Pages: 947-953, ISSN: 1472-0205
Flowerdew L, Brown R, Russ S, et al., 2012, Teams under pressure in the emergency department: an interview study, EMERGENCY MEDICINE JOURNAL, Vol: 29, ISSN: 1472-0205
Flowerdew L, Brown R, Vincent C, et al., 2012, Identifying Nontechnical Skills Associated With Safety in the Emergency Department: A Scoping Review of the Literature, ANNALS OF EMERGENCY MEDICINE, Vol: 59, Pages: 386-394, ISSN: 0196-0644
Flowerdew L, Brown R, Vincent C, et al., 2012, Development and Validation of a Tool to Assess Emergency Physicians' Nontechnical Skills, ANNALS OF EMERGENCY MEDICINE, Vol: 59, Pages: 376-385, ISSN: 0196-0644
Monroe K, Wang D, Vincent C, et al., 2011, Patient safety factors in children dying in a paediatric intensive care unit (PICU): a case notes review study, BMJ QUALITY & SAFETY, Vol: 20, Pages: 863-868, ISSN: 2044-5415
Wetzel CM, George A, Hanna GB, et al., 2011, Stress Management Training for Surgeons-A Randomized, Controlled, Intervention Study, ANNALS OF SURGERY, Vol: 253, Pages: 488-494, ISSN: 0003-4932
Wears RL, Woloshynowych M, Brown R, et al., 2010, Reflective analysis of safety research in the hospital accident & emergency departments, APPLIED ERGONOMICS, Vol: 41, Pages: 695-700, ISSN: 0003-6870
Arora S, Tierney T, Sevdalis N, et al., 2010, The Imperial Stress Assessment Tool (ISAT): A Feasible, Reliable and Valid Approach to Measuring Stress in the Operating Room, WORLD JOURNAL OF SURGERY, Vol: 34, Pages: 1756-1763, ISSN: 0364-2313
Arora S, Sevdalis N, Nestel D, et al., 2010, The impact of stress on surgical performance: A systematic review of the literature, SURGERY, Vol: 147, Pages: 318-330, ISSN: 0039-6060
Arora S, Hull L, Sevdalis N, et al., 2010, Factors compromising safety in surgery: stressful events in the operating room, AMERICAN JOURNAL OF SURGERY, Vol: 199, Pages: 60-65, ISSN: 0002-9610
Wetzel CM, Black SA, Hanna GB, et al., 2010, The effects of stress and coping on surgical performance during simulations., Ann Surg, Vol: 251, Pages: 171-176
OBJECTIVE: This study investigates the effects of surgeons' stress levels and coping strategies on surgical performance during simulated operations. METHODS: Thirty surgeons carried out each a non-crisis and a crisis scenario of a simulated operation. Surgeons' stress levels were assessed by several measures: self-assessments and observer ratings of stress, heart rate, heart rate variability, and salivary cortisol. Coping strategies were explored qualitatively and quantified to a coping score. Experience in surgery was included as an additional predictor. Outcome measures consisted of technical surgical skills using Objective Structured Assessment of Technical Skill (OSATS), nontechnical surgical skills using Observational Teamwork Assessment for Surgery (OTAS), and the quality of the operative end product using End Product Assessment (EPA). Uni- and multivariate linear regression were used to assess the independent effects of predictor variables on each performance measure. RESULTS: During the non-crisis simulation, a high coping score and experience significantly enhanced EPA (beta1, 0.279; 0.009-0.460; P= 0.04; beta2, 0.571; 4.328-12.669, P< 0.001; respectively). During the crisis simulation, a significant beneficial effect of the interaction of high experience and low stress on all performance measures was found (EPA: beta, 0.537; 2.079-8.543; OSATS: beta, 0.707; 8.708-17.860; OTAS: beta, 0.654; 13.090-30.483; P< 0.01). Coping significantly enhanced nontechnical skills (beta, 0.302; 0.117-1.624, P= 0.03). CONCLUSIONS: Clinicians' stress and coping influenced surgical performance during simulated operations. Hence, these are critical factors for the quality of health care.
Franklin BD, Birch S, Savage I, et al., 2009, Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions, PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Vol: 18, Pages: 992-999, ISSN: 1053-8569
Barber ND, Alldred DP, Raynor DK, et al., 2009, Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people, QUALITY & SAFETY IN HEALTH CARE, Vol: 18, Pages: 341-346, ISSN: 1475-3898
Barber ND, Alldred DP, Raynor DK, et al., 2009, Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people., Qual Saf Health Care, Vol: 18, Pages: 341-346
INTRODUCTION: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. METHODS: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. RESULTS: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff's high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. CONCLUSIONS: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.
Arora S, Sevdalis N, Nestel D, et al., 2008, Managing Intra-operative stress: What do surgeons want from a crisis training programme?, American Journal Surgery (in press)
Freeman GK, Woloshynowych M, Baker R, et al., 2007, Continuity of care 2006: What have we learned since 2000 and what are policy imperatives now? Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO).
Woloshynowych M, Vincent C, 2007, Patient safety and iatrogenesis, Cambridge Handbook of Psychology, Health and Medicine, Editors: Ayers, Baum, McManus, Newman, Wallston, Weinman, West, Cambridge UK, Publisher: Cambridge University Press, Pages: 472-477, ISBN: 978-0-521-60510-6
Nestel D, Woloshynowych M, Tierney T, et al., 2007, An Evaluation of Hybrid Simulations to Support Medical Students Learning Clinical Procedures - A Focus on Patient Safety and Communication., Simulation in Healthcare
BACKGROUND: Internal review highlighted teaching patient safety and communication skills associated with clinical procedures. Both topics feature in the General Medical Council’s document on graduate outcomes. Challenges included developing an educational intervention within a limited budget, large student cohorts (~380) and an already full curriculum.We aimed to provide opportunities for students to: * Reflect on progress towardsmeeting the GMC’s expectations * Observe and discuss ways to manage challenging patient safety and communication scenariosRESEARCH QUESTION: To what extent does the session raise students’ awareness of their responsibilities in patient safety and communication and provide practical strategies to manage relevant clinical scenarios?METHODS: The 3-hour session consisted of readings, reviews, observations and discussions, grounded in students’ experiences of clinical procedures. All activities focused on patient safety and communication. Using three hybrid simulations (where an actor is ‘seamlessly connected’ to simulation kit), students rated the degree to which they met learning objectives and the usefulness of educational methods.RESULTS: Eight sessions with group sizes of 25 to 47 students, 4 tutors and 3 actors were run. The response rate was 64%. Table 1 shows mean ratings of the degree to which students met learning objectives. The simulation activities had the highestmeanrating of educational methods (5.2, SD 1.1). Recommendations from students included better alignment of the session with timing of clinical attachments, making explicit links with other curriculum activities, highlighting professionalism, providing scenarios that deal with managing patients whoselanguage is different to their own, who are experiencing strong emotions and scenarios that demonstrate interactions with clinicians from other cultures.CONCLUSIONS: The session was highly valued and raised awareness of students’ respons
Woloshynowych M, Davis R, Brown R, et al., 2007, Communication Patterns in a UK Emergency Department, Annals of Emergency Medicine, Vol: 50, Pages: 407-413
Woloshynowych M, Davis R, Brown R, et al., 2006, Enhancing Safety in Accident and Emergency Care. Report of a series of studies funded by the National Patient Safety Research Programme.
Wetzel CM, Black SA, Kneebone RL, et al., 2006, Using simulations to investigate surgeons’ stress and coping strategies, Association of Surgeons of Great Britain and Ireland (ASGBI) Annual Meeting
Wetzel C, Kneebone R, Woloshynowych M, et al., 2006, The effect of stress on surgical performance, American Surgical Education
Tighe CM, Woloshynowych M, Brown R, et al., 2006, Incident reporting in one UK accident and emergency department., Accid Emerg Nurs, Vol: 14, Pages: 27-37, ISSN: 0965-2302
Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. This tool must be responsive and flexible to the local circumstances and work for the department to support the clinical governance agenda. In this paper, we describe the local processes for reporting and reviewing clinical incidents in one A&E department in a London teaching hospital and report recent changes to the system within the department. We used the historical data recorded on the Trust incident database as a representation of the information that would be available to the department in order to identify the high risk areas. In this paper, we evaluate the internal processes, the information available on the database and make recommendations to assist the emergency department in their internal processes. These will strengthen the internal review and staff feedback system so that the department can learn from incidents in a consistent manner. The process was reviewed by detailed examination of the centrally held electronic record (Datix database) of all incidents reported in a one year period. The nature of the incident and the level and accuracy of information provided in the incident reports was evaluated. There were positive aspects to the established system including evidence of positive changes made as a result of the reporting process, new initiatives to feedback to staff, and evolution of the programme
Woloshynowych M, Freeman G, Baker R, et al., 2006, Six years of Continuity of Care research: Emerging lessons from the English NHS., 7th Annual Conference of the International Network of Integrated Care
IntroductionContinuity of Care – or the lack of it - continues to challenge both users and service providers all over the developed world. Continuity was one of the first concerns raised at the SDO’s original listening exercise in 1999 in the context of increasing complexity of care delivery, both technical and particularly organisational. We have been reviewing the SDO’s five year continuity of care research programme. This (together with a parallel CHSRF programme) is one of the largest of its kind, focussing on the users’ experience and on longitudinal projects.MethodWe have visited each of the five largest projects (three still in progress) and read all available protocols, reports, presentations and publications. We have collaborated with the lead reviewer of the Canadian programme and briefly reviewed the continuity literature since 2000.FindingsThe emphasis on user experience is timely and welcome. It has thrown up some surprises – both methodological and in interpretation. It seems that some users find it difficult to conceptualise continuity (whether relational, managerial or informational) as distinct from other aspects of care delivery and this has been a serious challenge to designers of user centred measures. There are distinct differences between different health fields – particularly between mental health, chronic disease care in hospitals and in primary care. A common theme is the adverse effect of service reorganisation on continuity. There is a strongly positive association between all forms of continuity and satisfaction and still no clear evidence whether relationship continuity improves health outcomes.ImplicationsInvolving users has opened up important new perspectives, but also raised new methodological challenges. Policy makers and service providers need to give higher priority to continuity of care when planning organisational change. Continuity is a significant element of user satisfaction. The next prior
Wetzel CM, Black SA, Nestel D, et al., 2006, Development of High Fidelity Simulations for Exploring Surgical Stress
ABSTRACT # 1448 - POSTER BOARD # 87
Rogers S, Taylor-Adams S, Woloshynowych M, 2006, Techniques used in the investigation and analysis of critical incidents in healthcare., Patient Safety: Research Into Practice, Editors: Walshe, Boaden, Publisher: Open University Press, Pages: 130-143, ISBN: 9780335218530
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