Approach to Assessing the Preparedness of Hospitals to Power Outages

Within the secondary impacts of electricity blackouts, it is necessary to pay attention to facilities providing medical care for the population, namely the hospitals. Hospitals represent a key position in the provision of health care also in times of crisis. These facilities must provide constant care; it is therefore essential that the preparedness of such facilities is kept at a high level. The basic aim of this article is to analyse the preparedness of hospitals to power outages (power failures, blackouts) within a pilot study. On that basis, a SWOT analysis is used to determine strengths and weaknesses of the system of preparedness of hospitals to power outages and solutions for better security of hospitals are defined. The sample investigated consists of four hospitals founded by the Regional Authority (hospitals Nos. 1-4) and one hospital founded by the Ministry of Health of the Czech Republic (hospital No. 5). The results of the study shows that most weaknesses of the preparedness of hospitals are represented by inadequately addressed reserves of fuel for the main backup power supply, poor knowledge of employees who are insufficiently retrained, and old backup power supplies (even 35 years in some cases)

Design, validation and dissemination of an undergraduate assessment tool using SimMan® in simulated medical emergencies

Background: Increasingly, medical students are being taught acute medicine using whole-body simulator manikins. Aim: We aimed to design, validate and make widely available two simple assessment tools to be used with Laerdal SimMan (R) for final year students. Methods: We designed two scenarios with criterion-based checklists focused on assessment and management of two medical emergencies. Members of faculty critiqued the assessments for face validity and checklists revised. We assessed three groups of different experience levels: Foundation Year 2 doctors, third and final year medical students. Differences between groups were analysed, and internal consistency and interrater reliability calculated. A generalisability analysis was conducted using scenario and rater as facets in design. Results: A maximum of two items were removed from either checklist following the initial survey. Significantly different scores for three groups of experience for both scenarios were reported (p0.90). Internal consistency was poor (alpha<50.5). Generalizability study results suggest that four cases would provide reliable discrimination between final year students. Conclusions: These assessments proved easy to administer and we have gone some way to demonstrating construct validity and reliability. We have made the material available on a simulator website to enable others to reproduce these assessments

Anaesthesia in the MRI suite

Anaesthesia in the magnetic resonance imaging (MRI) suite, or when performing surgery that requires MRI guidance, is becoming a more frequent and complex procedure for anaesthetists, as the study modality is increasing in application. MRI is not inert in its ability to do harm and may interfere with the anaesthetist’s ability to assess the patient and intervene in the event of emergencies. Strong superconducting magnets can affect the physical environment and present unseen yet pertinent dangers, which may be avoided through awareness and vigilance. A culture of safety and collaboration in the radiology department, an area that is often remote from the usual milieu that anaesthetic providers are comfortable with, is essential to preventing serious injury or death to both patients and staff. It is therefore an important domain of knowledge and expertise for an anaesthetist. This article also describes some of the difficulties occasionally apparent only to the anaesthetic provider, which warrants anaesthetists’ involvement in the planning and layout of MRI suites.Keywords: anaesthesia, emergencies in MRI, magnetic resonance imaging (MRI), MRI safety, radiolog

Dynamic confidence during simulated clinical tasks

Objective: Doctors' confidence in their actions is important for clinical performance. While static confidence has been widely studied, no study has examined how confidence changes dynamically during clinical tasks. Method: The confidence of novice (n = 10) and experienced (n = 10) trainee anaesthetists was measured during two simulated anaesthetic crises, bradycardia (easy task) and failure to ventilate (difficult task). Results: As expected, confidence was high in the novice and experienced groups in the easy task. What was surprising, however, was that confidence during the difficult task decreased for both groups, despite appropriate performance. Conclusions: Given that confidence affects performance, it is alarming that doctors who may be acting unsupervised should lose dynamic confidence so quickly. Training is needed to ensure that confidence does not decrease inappropriately during a correctly performed procedure. Whether time on task interacts with incorrect performance to produce further deficits in confidence should now be investigated

The introduction of a surgical safety checklist in a tertiary referral obstetric centre

Background: Surgery-related adverse events remain a significant and often under-reported problem. In a recent study, the introduction of a perioperative checklist by the WHO reduced deaths and complications by 46% and 36% respectively. The authors wished to evaluate the introduction of a surgical safety checklist in a busy obstetric tertiary referral centre by assessing staff attitudes, checklist compliance and effects upon patients. Methods: A questionnaire-based assessment was performed on staff working in obstetric theatres before and after the introduction of the surgical safety checklist. Checklist compliance was assessed at 3 months and 1 year. Patients were asked questions relating to the performance of the surgical safety checklist in order to evaluate any anxiety caused. Results: Non-medical staff were significantly more likely than medical staff to feel familiar with other team members both before (p&lt;0.001) and after (

Hospital based maternity care in Ghana : findings of a confidential enquiry into maternal deaths

Background: In Ghana, a universal free delivery policy was implemented to improve access to delivery care in health facilities, thereby improving access to skilled attendance and reducing maternal mortality. Objective: A confidential enquiry was conducted to ascertain if changes had occurred in the care provided by reviewing the care given to a sample of maternal deaths before and after introduction of the policy. Method: Twenty women who died as a result of pregnancy-related complications (maternal deaths) in selected hospitals in two regions were assessed by a clinical panel, guided by a maternal death assessment form. Unlike the traditional confidential enquiry process, both adverse and favourable factors were identified. Findings: Clinical care provided before and after the introduction of the fee exemption policy did not change, though women with complications were arriving in hospital earlier after the introduction of the policy. On admission, however, they received very poor care and this, the clinical panel deduced could have resulted in many avoidable deaths; as was the case before the implementation of the policy. Consumables, basic equipment and midwifery staff for providing comprehensive emergency obstetric care were however found to be usually available. Conclusion: Our findings suggest that the already poor delivery care services women received remained unchanged after introduction of the policy.This work was undertaken as part of an international research programme - Immpact (Initiative for Maternal Mortality Programme Assessment). See: http://www.abdn.ac.uk/immpact, funded by the Bill & Melinda Gates Foundation, the Department for International Development (DFID), the European Commission and the Unites States Agency for International Development (USAID)

Knowledge of post-operative airway emergencies in recovery room nurses in selected hospitals

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in the partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesiology Johannesburg, 2015Background Recovery room nurses are required to have knowledge, skills and competency to recognise and safely manage post-operative airway emergencies in adult patients. Aim The aim of this study was to describe the level of knowledge of post-operative airway emergencies in recovery room nurses working at Chris Hani Baragwanath Academic Hospital (CHBAH), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Helen Joseph Hospital (HJH). Method A prospective, contextual and descriptive research design, involving a self-administered questionnaire was used. The questionnaire consisted of two sections: demographic data and knowledge based questioned, Convenience sampling was used. The sample population was formed by all recovery room nurses on duty at a given time, who voluntarily elected to participate. Results Descriptive statistics were used. The overall mean score obtained by the 24 participants was 46.2% (SD 21.7%) which is 23.8% below the competency score of 70%. The range of scores attained by participants was 8-75% with only five participants (20.8%) achieving a score ≥ 70%. Conclusion Recovery room nurses working at CHBAH, CMJAH and HJH did not have the necessary knowledge and competency required to safely provide quality nursing care to post-operative patients. The majority of participants failed to achieve a set competency score, representing adequate knowledge. As the study was contextual, the results could not be generalised.MT201

Rabbit neutering in primary-care education: insights from a surgical clinic

Involvement in canine and feline surgical neutering clinics is generally considered to be a key element of primary-care veterinary education, yet opportunities for veterinary students to develop their surgical skills with rabbit patients are uncommon. This is despite the fact that rabbits are currently estimated to be the third-most popular companion animal species and the fact that the British Small Animal Veterinary Association (BSAVA) recommends that all non-breeding rabbits be neutered soon after they attain sexual maturity. We describe a pilot rabbit-neutering clinic designed to provide high-quality care for rabbit patients while offering opportunities for undergraduate surgical and case-management skills development. We report on the clinical outcomes for patients. Rates of morbidity (n=18) and mortality (n=1) were low. Of complications reported, the majority (n=16) were considered minor. Challenges included ensuring that staff and students were trained in the specific features of rabbit anesthesia and recovery behavior. We conclude that rabbit surgical clinics offer excellent learning opportunities for undergraduate veterinary students. With prior training in handling and close individual supervision, it is possible to achieve good clinical outcomes and to have a positive impact on the welfare of companion animal populations

Anaesthetists' knowledge of appropriate adrenaline administration in three clinical scenarios

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesiology, Johannesburg, 2015Lack of knowledge and clinical experience in the event of an emergency are a lethal combination. Adrenaline is the drug of choice for resuscitation during cardiovascular collapse. Incorrectly dosing patients with adrenaline can lead to death by overdose or by undertreating the emergent condition. This highlights the importance, not only of resuscitation protocols but also the physician’s knowledge of and adherence to such guidelines. Research has consistently shown that physicians commonly make dosing mistakes during emergencies concerning adrenaline. Identifying whether or not this is due to a deficit in knowledge is important in understanding how to improve the outcomes of patients in such emergencies. The aim of this study was to determine the knowledge of anaesthetists working in the Department of Anaesthesiology at the University of the Witwatersrand regarding the appropriate administration of adrenaline for anaphylaxis, cardiac arrest and inotropic infusions. This was a prospective, contextual, descriptive study on a sample of anaesthetists working in the Department of Anaesthesiology at the University of the Witwatersrand. Anaesthetists who were willing to participate in the study were given a brief introduction to the study and a questionnaire to complete regarding adrenaline doses in three different clinical scenarios. Data collection took place during February 2014 and June 2014. Anaesthetists’ knowledge of adrenaline was analysed using descriptive and inferential statistics. The knowledge of Wits anaesthetists regarding adrenaline use in cardiac arrest, anaphylaxis and as an infusion, is inadequate. A total of 104 anaesthetists answered the questionnaire (n=104). The pass rate for the questionnaire was 14% (n=15). The median score for the questionnaire was 50%. A statistically significant difference was found between the pass rates of those anaesthetists who had attained an ACLS course and those who had not (p=0.0339). A weak correlation was found between anaesthetists knowledge and years of anaesthetic experience (r=0.2460). When comparing the knowledge of anaesthetists between different professional designations, a statistically significant difference was found between the intern groups’ knowledge and the consultants (33% vs 67%: p=0.0013). The study questionnaire uncovered major knowledge deficits in Wits anaesthetists, and revealed that ACLS certification improved knowledge in anaesthetists. This study warrants educational intervention and future investigation into knowledge improvement.MT201