Teams and cardiac surgery

Motivation\ud Our study is designed to identify human factors that are a threat to the safety of children with heart disease.\ud \ud Research approach\ud After an initial observation period, we will apply a major safety intervention. We will then re-measure the occurrence and types of human factors in the operating room, and the incidence of adverse events, near misses and hospital death, to evaluate if there was a significant post-intervention reduction. \ud \ud Findings/design\ud We focus on challenges encountered during the training of the observers. Research Limitations\ud Because of the complexity of the OR, observations are necessarily subjective. \ud \ud Originality/Value\ud This work is original because of the systematic evaluation of a safety intevention and the training protocol for the observers.\ud \ud Take Away Message\ud Systematic and periodic assessment of observers is required when teamwork is observed in complex, dynamic settings

Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review

Objectives Review available evidence for impact of electronic health records (EHRs) on predefined patient safety outcomes in interventional studies to identify gaps in current knowledge and design interventions for future research.Design Scoping review to map existing evidence and identify gaps for future research.Data sources PubMed, the Cochrane Library, EMBASE, Trial registers.Study selection Eligibility criteria: We conducted a scoping review of bibliographic databases and the grey literature of randomised and non-randomised trials describing interventions targeting a list of fourteen predefined areas of safety. The search was limited to manuscripts published between January 2008 and December 2018 of studies in adult inpatient settings and complemented by a targeted search for studies using a sample of EHR vendors. Studies were categorised according to methodology, intervention characteristics and safety outcome.Results from identified studies were grouped around common themes of safety measures.Results The search yielded 583 articles of which 24 articles were included. The identified studies were largely from US academic medical centres, heterogeneous in study conduct, definitions, treatment protocols and study outcome reporting. Of the 24 included studies effective safety themes included medication reconciliation, decision support for prescribing medications, communication between teams, infection prevention and measures of EHR-specific harm. Heterogeneity of the interventions and study characteristics precluded a systematic meta-analysis. Most studies reported process measures and not patient-level safety outcomes: We found no or limited evidence in 13 of 14 predefined safety areas, with good evidence limited to medication safety.Conclusions Published evidence for EHR impact on safety outcomes from interventional studies is limited and does not permit firm conclusions regarding the full safety impact of EHRs or support recommendations about ideal design features. The review highlights the need for greater transparency in quality assurance of existing EHRs and further research into suitable metrics and study designs

The Role of Telehealth in Enabling Sustainable Innovation and Circular Economies in Health

Digital health interventions including telehealth support an increasingly broad range of improvement goals for prevention and treatment. Limitations obstructing the many digital benefits of telehealth from reaching their full potential include lack of robust usability and user centered design, regulatory policy paradigms, lack of adequate high-quality evidence and methodologies to evaluate the performance generalization and clinical robustness. Health innovation is explored in the context of different value systems and a solution is proposed to the fundamental limitations arising in the data value system, an approach to a new telehealth paradigm and incorporated intervention designs which combine clinical innovation with innovation in data resource development. Machine learning and artificial intelligence have the potential to enable circular economies for digital and health innovation, in which sustainable solutions can be offered within a data-enabled collaborative and shared digital ecosystem. Alignment of industry standards, adjustments to regulatory policies, and embracing new governance models for telehealth-based innovation are essential for this new approach to health innovation scaling, clinical adoption and social innovation. Given the trends in technological advances in the past decades, it is likely that healthcare reliance on telehealth will continue to grow

Handover training: does one size fit all? The merits of mass customisation

Kicken, W., Van der Klink, M., Barach, P., & Boshuizen, H. P. A. (2012). Handover training: does one size fit all? The merits of mass customisation. British Medical Journal Quality & Safety, 21, i84-i88. doi:10.1136/bmjqs-2012-001164Background. Training plays an important role in improving handovers. However, the content and delivery of handover training are only superficially examined and poorly described in literature. The aim of this study is to formulate recommendations for an effective training in handover and to examine whether standardization is a viable solution. Methods. A training needs analysis was conducted by means of a questionnaire, which was filled out by 96 healthcare professionals in primary and secondary care in the Netherlands, Spain, Sweden, and Poland. Preferences and recommendations regarding training delivery aspects and training topics that should be included in a training for handover were measured. Results. The majority of the participants recommended to provide a short conventional training with practical assignments to a small, multidisciplinary group. Formal examination, e-learning and self-study were not favoured. Recommended training topics were: communication skills, standardized procedures, knowing what to hand over, alertness to vulnerable patient groups, and awareness of responsibility. Small differences between countries pertain to suggested solutions to handover problems, such as reducing the time interval between discharge and discharge letter (The Netherlands), ensure information is handed over at all (Poland), and more standardized procedures and information systems (Sweden and Spain). Conclusions. The idea of a completely standardized handover training is not in line with the identified differences in preferences and recommendations between different handover stakeholders. Instead mass customization of training in which a generic training can easily be adapted to the trainees’ needs, based on examinations of, for example, their preferences or identified handover problems and solutions, is a more promising approach to handover training.FP7-HEALTH-F2-2008-22340

"It's like two worlds apart": an analysis of vulnerable patient handover practices at discharge from hospital.

BACKGROUND: Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. OBJECTIVE: To explore handover practices at discharge and to focus on the patients' role in handovers and on the potential additional risks for vulnerable patients. METHODS: We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain. RESULTS: We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems. CONCLUSIONS: Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment

The Handover Toolbox: a knowledge exchange and training platform for improving patient care

Drachsler, H., Kicken, W., Van der Klink, M., Stoyanov, S., Boshuizen, H. P. A., & Barach, P. (2012). The Handover Toolbox: a knowledge exchange and training platform for improving patient care. British Medical Journal Quality & Safety, 21, 1114–1120. doi:10.1136/bmjqs-2012-001176Objective Safe and effective patient handovers remain a global organizational and training challenge. The World Health Organization (WHO) lists effective handovers as one of its High 5 patient safety initiatives. Training for handover competencies is a promising approach to improve the quality of handovers. We present the Handover toolbox that aims to support different stakeholders (e.g. general practitioners, nurses, medical trainer, experts in patient handover, and medical students) to provide customized handover training for specific demands. Methods The Handover toolbox was designed in the context of the FP7 HANDOVER project from April 2009 until October 2011 by using the Technology Enhanced Learning Design Process (TEL-DP). TEL-DP consisted of six different methods: 1). User requirements analysis; 2). Writing personas; 3). Group Concept Mapping 4). Analysis of suitable software; 5). Plus-Minus-Interesting rating; and 6). Usability testing. TEL-DP is aligned to participatory design approaches and guaranteed a development process in close collaboration with the stakeholders. Results From method (1) it appeared that different kinds of trainings are needed that allow to train professionals on the job as well as medical students in their studies. Methods (2) and (3) made clear that training experts from different countries differed in their views on the desired content and delivery of handover training. This means that a one-size-fits-all training was not applicable rather a customisable learning approach, a toolbox, that allow trainers to design their own training for various target groups with specific handover information needs was a far better solution. Method (4) identified the most suitable ready-to-use software systems that provided the required functionalities and could be further customized to the needs of the users. Method (5) and (6) resulted in several points for improvement of the Handover toolbox, mainly related to improved usability and navigation. Until the end of the development process in October 2011, 165 training experts were attracted by the toolbox and signed up for the system. Conclusions We developed a Handover toolbox for different stakeholders who are interested in improving handovers through customized training and learning. Its design is based on a carefully stakeholder investigation, using the TEL-DP approach which is a systematic and comprehensive design approach. It provides state of the art content about 40 handover tools with practical guidelines, a generic training design that can be customized to specific handover training needs, and enables community members to contribute own experiences and best practice examples. Next to this content, it offers an easy to use e-learning environment to support trainers in their handover classes. The developments can only be seen as a first supportive step to achieve a better patient safety. The final implementation phase of the toolbox has only partly been achieved within the FP7 HANDOVER project. Europe’s medical schools need additional support to implement the toolbox into their medical education system. Therefore, a follow-up implementation project was designed that will apply the toolbox in three University Hospitals in Germany, Spain, and Ireland.FP7 Handover, LLP PATIEN

Flexibility during the covid-19 pandemic response: Healthcare facility assessment tools for resilient evaluation

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the ex-traordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies