Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO) : primary research

Background and objectives: Handover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover. Methods: Three NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways. Results: Handover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows. Conclusions: The research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued

Case Management Program For Frail Elders Manual, August 2008

The purpose of this manual is to guide operation of the Case Management Program for Frail Elders. After Background, Program Administration, Definitions, Consumer Eligibility, and Program Standards, the order follows the flow of a consumer entering the pro-gram from referral through ongoing case activities. The manual is written assuming the reader is the Case Manager. The effective date will appear in the bottom left hand corner of each page. This manual will be updated as needed via Iowa Aging Program Instructions (IAPI). This manual is used in conjunction with the Department of Human Services’ manuals which provide more detail about policies and procedures within the Medicaid elderly waiver program

Managing post-disaster reconstruction finance -- international experience in public financial management

In recent years, natural and man-made disasters have confronted the international community with its most demanding reconstruction challenges since the aftermath of World War II. Managing the inflow of resources and spending those resources well have proven to be two of the main difficulties in such reconstruction projects, particularly after large-scale disasters. A central dilemma of the public financial management of reconstruction is the need for very high levels of accountability to demonstrate fiduciary credibility, while at the same time ensuring the rapid implementation of recovery programs. This paper identifies options and lessons for managing post-disaster reconstruction finance in three key areas: (i) the establishment of special institutions to manage the reconstruction process; (ii) the selection of public financial management systems with respect to the application of country systems, special fiduciary arrangements, or donor/NGO execution; and (iii) monitoring and evaluation systems. The authors synthesize the phasing of assistance and approaches in eight recent post-natural disaster reconstruction efforts (Aceh-Indonesia, Yogyakarta-Indonesia, Sri Lanka, Maldives, Pakistan, Colombia, Grenada, and Honduras) to help guide the priorities and options for future instances of public financial management for disaster reconstruction. The paper also compares the challenges posed by post-conflict versus post-natural disaster public financial management.Natural Disasters,Disaster Management,Post Conflict Reconstruction,Social Accountability,Post Conflict Reintegration

Maximizing Productivity: Accomodations for Emergency Preparedness

[Excerpt] Emergency planning is just as critical for the workplace as it is for the home. In recent years, the nation, particularly the federal government, has re-evaluated its approach to emergency preparedness and response. While significant strides have been made, much work remains to be done. Research and anecdotal evidence indicate that such planning, preparedness, response and recovery efforts often overlook the needs and perspectives of people with disabilities

The competences of command cadre of the airport fire service on the example of safety assurance of Warsaw Okęcie Airport

The globalization process in almost all spheres of our life causes a possibility of making equal living standards in all countries of the world. An introduction to globalization was undoubtedly the development of air transport which greatly accelerated the possibility of travelling on all continents. Along with the development of technology, airplanes used for carrying people and cargo become much better, quicker, but they also become more and more complicated in respect of their construction. This also gives rise to requirements that airports have to comply with, i.e. in order to receive super modern machines they must be equipped with modern navigational facilities, modern equipment for surface handling of airplanes and passengers. This, in turn, requires a continuous development of knowledge and competence from airport staff to be flexible in the constantly modernized environment. In consideration of a rapid development of air transport, and consequently its increasing importance for the world economy countries face a problem how to assure the high quality of aviation services, its access for a man-in-the-street, and first of all safety in its broad meaning, which is a synonym of quality in air transport. Nowadays, this is the main problem in air transport which has priority before the comfort of a traveller. Safety in aviation is approached in two dimensions – prevention of occurrence events and removal of results of unforeseeable incidents, accidents or catastrophes. A special part in this area is performed by the airport rescue and firefighting service, commonly called the Airport Fire Service (AFS). The main requirement for airport rescuers set by the International Civil Aviation Organization (ICAO) is conducting rescue and firefighting operations in case of an aircraft or airport incident (disaster) [...]

Managing disaster preparedness for institution of higher learning: A study in Perlis

Unprecedented floods disaster that hit Johore, Pahang, Terengganu and Kelantan was due to abnormal weather conditions. Heavy rain which fall continuously non stop for between 3 to 4 days has raised the water level in some areas to a height of 15 feet deep. The flood disasters have caused devastating loss of property and life and some 100,000 people were evacuated to flood relief centers. Some of the floods victim lost all their belonging and property. Flood disaster has also caused water borne diseases to prevail. The future is bleak for these flood victims. Continuous government assistance is needed for these flood victims who lost everything is needed. Year in and year out, the monsoon season have cause floods disaster especially in the east coast state and is now a yearly common phenomena. However, the level of awareness and preparedness among the Malaysian community and the government machinery is still questionably low. Presently, there are 18 public universities in the country, the issue is what is the level of awareness does students and staff of the university put on the issue of floods or other natural disaster? Do we at the University are ready to face disaster situations if it occur in the University? At this juncture, the experiences of UniMAP’s contribution to the University’s community, the local community vis-à-vis the Malaysian Mechanism Disaster Management and functioning alongside the state machinery of Perlis state government during 17 December 2005 flood disaster can be used as an example. The aim of this study is to examine the disaster preparedness in University and to propagate the importance of disaster preparedness among the students and staffs through education. This pilot project will be conducted through interviews, observations and surveys. It is expected that this study will shed some light for further effective implementation of disaster preparedness management