What influences adherence to guidance for post-operative instillation of intravesical chemotherapy to bladder cancer patients?

Open Access via the Jisc Wiley Agreement Wellcome Trust - Institutional Strategic Support Fund (GrantNumber(s): 204815/Z/16/A)Peer reviewedPostprintPublisher PD

A nurse led assessment prior to elective admission for surgery

'This thesis reports on a study undertaken at an NHS Trust during a thirty month period commencing January 1994. The aim of the study was to evaluate the results of a preoperative assessment clinic for adult patients due to undergo major and minor elective surgery, (other than those admitted for gynaecological procedures). The primary focus was on hospital efficiency, within government initiatives, and the use of assessment as a means to guarantee a bed on admission, reducing theatre cancellations and waiting list times. The main outcome measures are the reduced theatre cancellation rates, increased patient throughput, and a clear reduction in length of stay. A secondary theme was explored, that of multi-disciplinary collaboration in particular doctor nurse collaboration; the role and ability of an advanced nursing role, whereby the assessment clinic provided the environment for comparison of patient outcome between those seen by doctor or by nurse assessor. The study compared all patient admission episodes and outcomes with respect to patients assessed and those not assessed. The study is able to demonstrate that a nurse performed at least as well as the doctor

Smoking, alcohol and obesity: Health promotion opportunities relevant to acutely ill vascular and urology patients.

Alcohol, smoking and obesity are considered serious public health issues. This article examines the nurses’ role in health promotion and considers the legal, ethical and policy context relevant to a group of acutely ill patients on a vascular surgery and urology ward. It discusses how the majority of these patients suffer from vascular disease, primarily caused by modifiable risk factors and explores how to empower individuals to manage and improve their own health. The article concludes that nurses have a duty to help individuals to make informed decisions regarding their health. However, patients are entitled to make their own choices and the nurse must be respectful of their autonomy

Interprofessional Teamwork in Hospital Units: A human factors approach to patient safety

Introduction Human factors, such as teamwork and communication, have an important impact on patient safety in hospitals. Hospitals have a patient safety problem, with more than every 10th patient experiencing errors and adverse events during their hospital stay. Root cause analysis have showed that ineffective teamwork and communication failures are the most common causes of errors and adverse events. To improve patient safety in hospital units, healthcare professionals needs competency in teamwork, such as communication, decision making, leadership, situational monitoring and mutual support. Interprofessional team training is a key strategy for improving teamwork and patient safety in hospital units. Previous research on interprofessional team training in specialty units has showed promising results; however, the impact on surgical wards is uncertain. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program had not been implemented in Norway. Team decisionmaking has not yet been studied previously among multiple healthcare professionals across diverse hospital units. Aim The overall aim of the thesis is to gain knowledge about teamwork in hospital units and to evaluate and explore the impact of an interprofessional team training intervention regarding teamwork and patient safety culture in a surgical ward. The specific aims of the sub-studies are as follows: 1) To translate the CSACD-T questionnaire into Norwegian and test it for psychometry properties. The further aim is to describe and compare healthcare personnel's perceptions of collaboration and satisfaction about team decision-making across hospital units (Study I, paper 1). 2) To evaluate the professional and organizational outcomes of an interprofessional teamwork intervention among healthcare professionals in a surgical ward after 6 and 12 months (Study II, paper 2). 3) To explore if an interprofessional teamwork intervention in a surgical ward changes the healthcare personnel’s perceptions of patient safety culture, perceptions of teamwork, and attitudes toward teamwork over 12 months (Study II, paper 3). Methods Study I (paper 1) had a cross-sectional design. The Collaboration and Satisfaction About Care Decisions in teams (CSACD-T) questionnaire was used for the survey conducted among healthcare professionals across multiple hospital units (hospital A and B). Study II (paper 2) used a pre-post design with re-measurement (hospital C), with surveys (CSACD-T, TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), and Hospital Survey of Patient Safety Culture (HSOPS)) distributed to healthcare professionals in the intervention ward at baseline and after 6 and 12 months. Study II (paper 3) used a controlled quasi-experimental design, with surveys (CSACD-T, T-TPQ, HSOPS, and TeamSTEPPS Teamwork Attitude Questionnaire (T-TAQ)) distributed to all healthcare professionals in the intervention ward and control ward (hospitals C and D) at baseline and after 12 months. The intervention was a 6-hour TeamSTEPPS interprofessional team training included simulation training, followed by implementation of teamwork tools and strategies in the ward over 12 months (hospital C). The implementation followed Kotter’s eight steps for leading change. The human factors systems engineering initiative for patient safety (SEIPS) model was used as a theoretical perspective. Results The CSACD-T questionnaire showed promising psychometric properties in terms of construct validity and internal consistency. The scores of collaboration and satisfaction with care decisions in teams varied among unit types and were highest among the healthcare professionals in the wards, with a significant difference between the maternity ward and emergency room (paper I). The outcomes from the intervention study showed significant changes in organizational outcomes after six months, and were in the following areas of patient safety culture: “Organizational Learning and Continuous Improvement” and “Communication Openness” (paper 2). After 12 months, significant changes were found in professional outcomes within the intervention ward, which were in three perceptions of teamwork dimensions: “Situation Monitoring,” “Mutual Support,” and “Communication”, in addition to organizational outcomes, which were in three patient safety culture dimensions: “Communication Openness,” “Teamwork Within Unit,” and “Manager’s Expectations & Actions Promoting Patient Safety” (papers 2 and 3). The improved teamwork dimension “Mutual Support” was found to be a predictor of “Patient Safety Grade” (paper 2). The controlled results revealed significant differences favoring the intervention ward in three patient safety culture measures: “Teamwork Within Unit,” “Overall Perceptions of Patient Safety” and “Patient Safety Grade” (paper 3). Conclusion This thesis presents new insights into team decision-making in diverse hospital units, as reported by healthcare professionals from multiple healthcare professions. The thesis also presents new insights into the impact of an interprofessional TeamSTEPPS intervention in a surgical ward in Norway. The outcomes are promising, indicating that TeamSTEPPS intervention improves teamwork and patient safety culture in a surgical ward. The causal relationships among inputs, processes, and outcomes are, however, not certain, and further studies are required to confirm the outcomes of this comprehensive and well-described interprofessional team-training intervention. Nevertheless, the knowledge from this thesis adds to the vast field of teamwork and patient safety research internationally

Integral resource capacity planning for inpatient care services based on hourly bed census predictions

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theater and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule (MSS) and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (i.e., case mix, care unit size, care unit partitioning), tactical (i.e., allocation of operating room time, misplacement rules), and operational decisions (i.e., time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision support tool in a complete redesign of the inpatient care operations

Acceptability of medical digital libraries

Evidenced-based medicine has increased the importance of quick accessibility to reputable, upto-date information. Web-accessible digital libraries (DLs) on the wards can address the demand for such information. The use and acceptability of these resources has, however, been lower than expected due to a poor understanding of the context of use. To appreciate the social and organizational impacts of ward-accessible DLs for clinicians, results of a study within a large London-based hospital are presented. In-depth interviews and focus groups with 73 clinicians (from pre-registration nurses to surgeons) were conducted, and the data analysed using the grounded theory method. It was found that clinical social structures interact with inadequate training provision (for senior clinicians), technical support and DL usability to produce a knowledge gap between junior and senior staff, resulting in information – and technology – hoarding behaviours. Findings also detail the perceived effectiveness of traditional and digital libraries and the impact of clinician status on information control and access. One important conclusion is that increased DL usability and adequate support and training for senior clinicians would increase perceptions of DLs as support for, rather than replacement of, their clinical expertise. © 2002, The Continuum Publishing Group Ltd. All rights reserved

Guide for third and fourth year students

Advice complied by Boston University School of Medicine students for incoming first year students and third or fourth year students preparing for clinical rotations

Digital libraries in a clinical setting: Friend or foe?

Clinical requirements for quick accessibility to reputable, up-to-date information have increased the importance of web accessible digital libraries for this user community. To understand the social and organisational impacts of ward-accessible digital libraries (DLs) for clinicians, we conducted a study of clinicians. perceptions of electronic information resources within a large London based hospital. The results highlight that although these resources appear to be a relatively innocuous means of information provision (i.e. no sensitive data) social and organisational issues can impede effective technology deployment. Clinical social structures, which produce information. and technology. hoarding behaviours can result from poor training, support and DL usability