266 results found
Kirkman MA, Muirhead W, Sevdalis N, 2017, The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study, JOURNAL OF NEUROSURGERY, Vol: 126, Pages: 304-311, ISSN: 0022-3085
Soukup Ascencao T, Petrides VK, Lamb BW, et al., 2016, The anatomy of clinical decision-making in multidisciplinary cancer meetings: a cross-sectional observational study of teams in a natural context, Medicine, Vol: 95, ISSN: 0025-7974
Abstract: In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable.The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision.This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons.We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis.The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = -0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001).Hawthorne effect is the main limitation of the study.The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient prof
Harris J, Taylor C, Sevdalis N, et al., 2016, Development and testing of the cancer multidisciplinary team meeting observational tool (MDT-MOT), INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 28, Pages: 332-338, ISSN: 1353-4505
Athanasiou T, Patel V, Garas G, et al., 2016, Mentoring perception and academic performance: an Academic Health Science Centre survey, Postgraduate Medical Journal, Vol: 92, Pages: 597-602, ISSN: 1469-0756
Purpose To determine the association between professors' self-perception of mentoring skills and their academic performance.Design Two hundred and fifteen professors from Imperial College London, the first Academic Health Science Centre (AHSC) in the UK, were surveyed. The instrument adopted was the Mentorship Skills Self-Assessment Survey. Statement scores were aggregated to provide a score for each shared core, mentor-specific and mentee-specific skill. Univariate and multivariate regression analyses were used to evaluate their relationship with quantitative measures of academic performance (publications, citations and h-index).Results There were 104 professors that responded (response rate 48%). There were no statistically significant negative correlations between any mentoring statement and any performance measure. In contrast, several mentoring survey items were positively correlated with academic performance. The total survey score for frequency of application of mentoring skills had a statistically significant positive association with number of publications (B=0.012, SE=0.004, p=0.006), as did the frequency of acquiring mentors with number of citations (B=1.572, SE=0.702, p=0.030). Building trust and managing risks had a statistically significant positive association with h-index (B=0.941, SE=0.460, p=0.047 and B=0.613, SE=0.287, p=0.038, respectively).Conclusions This study supports the view that mentoring is associated with high academic performance. Importantly, it suggests that frequent use of mentoring skills and quality of mentoring have positive effects on academic performance. Formal mentoring programmes should be considered a fundamental part of all AHSCs’ configuration.
Sevdalis N, Arora S, 2016, Safety standards for invasive procedures, BMJ-BRITISH MEDICAL JOURNAL, Vol: 352, ISSN: 1756-1833
Howell AR, Burns EM, Hull L, et al., 2016, International recommendations for national patient safety incident reporting systems: An expert Delphi consensus-building process, BMJ Quality and Safety, Vol: 26, Pages: 150-163, ISSN: 2044-5415
Background Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care.Objective To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role.Methods After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised.Results Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally.Conclusions We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally.
Harthug S, Haugen AS, Softeland E, et al., 2016, Effect of the World Health Organization Checklist on Patient Outcomes: A Stepped Wedge Cluster Randomized Controlled Trial Reply, ANNALS OF SURGERY, Vol: 263, Pages: E24-E25, ISSN: 0003-4932
Kapur N, Parand A, Soukup T, et al., 2016, Aviation and healthcare: a comparative review with implications for patient safety., JRSM Open, Vol: 7, ISSN: 2054-2704
Safety in aviation has often been compared with safety in healthcare. Following a recent article in this journal, the UK government set up an Independent Patient Safety Investigation Service, to emulate a similar well-established body in aviation. On the basis of a detailed review of relevant publications that examine patient safety in the context of aviation practice, we have drawn up a table of comparative features and a conceptual framework for patient safety. Convergence and divergence of safety-related behaviours across aviation and healthcare were derived and documented. Key safety-related domains that emerged included Checklists, Training, Crew Resource Management, Sterile Cockpit, Investigation and Reporting of Incidents and Organisational Culture. We conclude that whilst healthcare has much to learn from aviation in certain key domains, the transfer of lessons from aviation to healthcare needs to be nuanced, with the specific characteristics and needs of healthcare borne in mind. On the basis of this review, it is recommended that healthcare should emulate aviation in its resourcing of staff who specialise in human factors and related psychological aspects of patient safety and staff wellbeing. Professional and post-qualification staff training could specifically include Cognitive Bias Avoidance Training, as this appears to play a key part in many errors relating to patient safety and staff wellbeing.
Pannick S, Sevdalis N, Athanasiou T, 2015, Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities, BMJ Quality & Safety, Vol: 25, Pages: 716-725, ISSN: 2044-5423
Despite taking advantage of established learning from other industries, quality improvementinitiatives in healthcare may struggle to outperform secular trends. The reasons for this arerarely explored in detail, and are often attributed merely to difficulties in engaging cliniciansin quality improvement work. In a narrative review of the literature, we argue that this focuson clinicians, at the relative expense of managerial staff, has proven counterproductive.Clinical engagement is not a universal challenge; moreover, there is evidence that managers– particularly middle managers – also have a role to play in quality improvement. Yetmanagerial participation in quality improvement interventions is often assumed, rather thanproven. We identify specific factors that influence the coordination of frontline staff andmanagers in quality improvement, and integrate these factors into a novel model: the modelof alignment. We use this model to explore the implementation of an interdisciplinaryintervention in a recent trial, describing different participation incentives and barriers fordifferent staff groups. The extent to which clinical and managerial interests align may be animportant determinant of the ultimate success of quality improvement interventions.
Hull L, Arora S, Stefanidis D, et al., 2015, Facilitating the implementation of the American College of Surgeons/Association of Program Directors in Surgery phase III skills curriculum: training faculty in the assessment of team skills, AMERICAN JOURNAL OF SURGERY, Vol: 210, Pages: 933-+, ISSN: 0002-9610
Zingg W, Castro Sanchez EM, Secci, et al., 2015, Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS), Public Health, ISSN: 0033-3506
Kokkinaki F, Sevdalis N, 2015, Effect of Motivational Goals on the Causal Realism of Counterfactual Thoughts, JOURNAL OF PSYCHOLOGY, Vol: 149, Pages: 643-664, ISSN: 0022-3980
Hull L, Sevdalis N, 2015, Advances in Teaching and Assessing Nontechnical Skills, SURGICAL CLINICS OF NORTH AMERICA, Vol: 95, Pages: 869-+, ISSN: 0039-6109
Miles A, McClements PL, Steele RJC, et al., 2015, The Psychological Impact of a Colorectal Cancer Diagnosis Following a Negative Fecal Occult Blood Test Result, CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, Vol: 24, Pages: 1032-1038, ISSN: 1055-9965
Kirkman MA, Muirhead W, Sevdalis N, et al., 2015, Simulated Ventriculostomy Training With Conventional Neuronavigational Equipment Used Clinically in the Operating Room: Prospective Validation Study, JOURNAL OF SURGICAL EDUCATION, Vol: 72, Pages: 704-716, ISSN: 1931-7204
Pannick S, Beveridge I, Ashrafian H, et al., 2015, A stepped wedge, cluster controlled trial of an intervention to improve safety and quality on medical wards: the HEADS-UP study protocol, BMJ Open, Vol: 5, ISSN: 2044-6055
Introduction The majority of preventable deaths in healthcare are due to errors on general wards. Staff perceptions of safety correlate with patient survival, but effectively translating ward teams’ concerns into tangibly improved care remains problematic. The Hospital Event Analysis Describing Significant Unanticipated Problems (HEADS-UP) trial evaluates a structured, multidisciplinary team briefing, capturing safety threats and adverse events, with rapid feedback to clinicians and service managers. This is the first study to rigorously assess a simpler intervention for general medical units, alongside an implementation model applicable to routine clinical practice.Methods/analysis 7 wards from 2 hospitals will progressively incorporate the intervention into daily practice over 14 months. Wards will adopt HEADS-UP in a pragmatic sequence, guided by local clinical enthusiasm. Initial implementation will be facilitated by a research lead, but rapidly delegated to clinical teams. The primary outcome is excess length of stay (a surplus stay of 24 h or more, compared to peer institutions’ Healthcare Resource Groups-predicted length of stay). Secondary outcomes are 30-day readmission or excess length of stay; in-hospital death or death/readmission within 30 days; healthcare-acquired infections; processes of escalation of care; use of traditional incident-reporting systems; and patient safety and teamwork climates. HEADS-UP will be analysed as a stepped wedge cluster controlled trial. With 7840 patients, using best and worst case predictions, the study would achieve between 75% and 100% power to detect a 2–14% absolute risk reduction in excess length of stay (two-sided p<0.05). Regression analysis will use generalised linear mixed models or generalised estimating equations, and a time-to-event regression model. A qualitative analysis will evaluate facilitators and barriers to HEADS-UP implementation and impact.Ethics and dissemination Participating in
Pannick S, Davis R, ashrafian H, et al., 2015, Effects of interdisciplinary team care interventions on general medical wards. A systematic review., JAMA Internal Medicine, Vol: 175, Pages: 1288-1298, ISSN: 2168-6114
Importance Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams’ performance improves patient outcomes in other settings, and interdisciplinary practice is a major target for improvement efforts. However, the effect of interdisciplinary team interventions on general medical ward care has not been systematically reviewed.Objectives To describe the range of objective patient outcomes used in studies of general medical ward interdisciplinary team care, and to evaluate the performance of interdisciplinary interventions against them.Evidence Review We searched EMBASE, MEDLINE, and PsycINFO from January 1, 1998, through December 31, 2013, for interdisciplinary team care interventions in adult general medical wards using an objective patient outcome measure. Reference lists of included articles were also searched. The last search was conducted on January 29, 2014, and the narrative and statistical analysis was conducted through December 1, 2014. Study quality was assessed using the Cochrane Effective Practice and Organization of Care group’s tool.Findings Thirty of 6934 articles met the selection criteria. The studies included 66 548 patients, with a mean age of 63 years. Nineteen of 30 (63%) studies reported length of stay, readmission, or mortality rate as their primary outcome, or did not specify the primacy of their outcomes. The most commonly reported objective patient outcomes were length of stay (23 of 30 [77%]), complications of care (10 of 30 [33%]), in-hospital mortality rate (8 of 30 [27%]), and 30-day readmission rate (8 of 30 [27%]). Of 23 interventions, 16 (70%) had no effect on length of stay, 12 of 15 (80%) did not reduce readmissions, and 14 of 15 (93%) did not affect mortality. Five of 10 (50%) interventions reduced complications of care. In an exploratory quantitative analysis, the
Jilka SR, Callahan R, Sevdalis N, et al., 2015, "Nothing About Me Without Me": An Interpretative Review of Patient Accessible Electronic Health Records, Journal of Medical Internet Research, Vol: 17, ISSN: 1439-4456
BackgroundPatient accessible electronic health records (PAEHRs) enable patients to access and manage personalclinical information that is made available to them by their health care providers (HCPs). It is thought thatthe shared management nature of medical record access improves patient outcomes and improves patientsatisfaction. However, recent reviews have found that this is not the case. Furthermore, little research hasfocused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers.ObjectiveWe provide a systematic review of reviews of the impact of giving patients record access from both apatient and HCP point of view. The review covers a broad range of outcome measures, including patientsafety, patient satisfaction, privacy and security, self-efficacy, and health outcome.MethodsA systematic search was conducted using Web of Science to identify review articles on the impact ofPAEHRs. Our search was limited to English-language reviews published between January 2002 andNovember 2014. A total of 73 citations were retrieved from a series of Boolean search terms including“review*” with “patient access to records”. These reviews went through a novel scoring system analysiswhereby we calculated how many positive outcomes were reported per every outcome measureinvestigated. This provided a way to quantify the impact of PAEHRs.Results1 1 2 1112Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well asHCPs were found but eight were included for the analysis of outcome measures. We found mixedoutcomes across both patient and HCP groups, with approximately half of the reviews showing positivechanges with record access. Patients believe that record access increases their perception of control;however, outcome measures thought to create psychological concerns (such as patient anxiety as a result ofseeing their medical record) are still unanswered. Nurses are more likely th
Matharoo MK, Baldwin R, Haycock A, et al., 2015, THE COLORECTAL CANCER MDT: HOW MANY ERRORS OCCUR, DO THEY MATTER AND CAN THEY BE AVERTED?, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A220-A221, ISSN: 0017-5749
Morar P, Sevdalis N, Read J, et al., 2015, ESTABLISHING ELIGIBILITY FOR CASE DISCUSSION IN MULTIDISCIPLINARY TEAM CARE WITHIN AN INFLAMMATORY BOWEL DISEASE SERVICE PROVISION - RESULTS FROM A QUALITATIVE TWO-STAGE EXPERT BASED STUDY, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A184-A184, ISSN: 0017-5749
Matharoo MK, Baldwin R, Jenkins J, et al., 2015, QUALITY IMPROVEMENT IN THE COLORECTAL CANCER MULTI-DISCIPLINARY TEAM (MDT): A PROSPECTIVE EVALUATION OF TEAM FACTORS, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A221-A222, ISSN: 0017-5749
Wheelock A, Suliman A, Wharton R, et al., 2015, The Impact of Operating Room Distractions on Stress, Workload, and Teamwork, ANNALS OF SURGERY, Vol: 261, Pages: 1079-1084, ISSN: 0003-4932
Pannick S, Beveridge I, Sevdalis N, 2015, HEADS-UP: a novel intervention to improve clinical outcomes with daily, team-based risk recognition., Medicine 2015: Royal College of Physicians Annual Conference 2015, ISSN: 1470-2118
Kirkman MA, Sevdalis N, Arora S, et al., 2015, The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review, BMJ Open, Vol: 5, ISSN: 2044-6055
Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic.Design A systematic review.Data sources Embase, Ovid Medline and PsycINFO databases.Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014.Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions.Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation.Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread.
Arora S, Hull L, Fitzpatrick M, et al., 2015, Crisis Management on Surgical Wards A Simulation-based Approach to Enhancing Technical, Teamwork, and Patient Interaction Skills, ANNALS OF SURGERY, Vol: 261, Pages: 888-893, ISSN: 0003-4932
Haugen AS, Softeland E, Almeland SK, et al., 2015, Effect of the World Health Organization Checklist on Patient Outcomes A Stepped Wedge Cluster Randomized Controlled Trial, ANNALS OF SURGERY, Vol: 261, Pages: 821-828, ISSN: 0003-4932
Hughes J, Soukup T, Mace A, et al., 2015, Head and Neck Cancer Multidisciplinary Team Meeting Quality Improvement: The Impact of a New Patient Information Delivery Tool, British Association of Head & Neck Oncologists (BAHNO)
Wheelock A, Parand A, Rigole B, et al., 2015, Socio-Psychological Factors Driving Adult Vaccination: A Qualitative Study (vol 9, e113503, 2014), PLOS ONE, Vol: 10, ISSN: 1932-6203
Mayer EK, Sevdalis N, Rout S, et al., 2015, Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study, Annals of Surgery, Vol: 263, Pages: 58-63, ISSN: 1528-1140
OBJECTIVE: To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. BACKGROUND: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. METHODS: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. RESULTS: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37-0.87, P < 0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. CONCLUSIONS: Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.
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