Correlation between safety attitudes and early adoption of cognitive aids in the German culture sphere: a multicenter survey study

Background: Cognitive Aids (checklists) are a common tool to improve patient safety. But the factors for their successful implementation and continuous use are not yet fully understood. Recent publications suggest safety culture to play a key role in this context. However, the effects on the outcome of implementation measures remain unclear. Hospitals and clinics that are involved in cognitive aid development and research might have significantly different safety cultures than their counterparts, resulting in skewed assessments of proper implementation. Therefore, the objective of this study was to assess the correlation between cognitive aid implementation and safety attitudes of staff members in early adopting and later adopting clinics. Methods: An online survey of the Safety Attitudes Questionnaire (SAQ) was carried out in German anaesthesiology departments during the initial implementation of a new checklist for emergencies during anesthesia (“eGENA” app). Subsequently an analysis between subgroups (“eGENA” app usage and occupation), with Kruskal–Wallis- and Mann–Whitney-U-Tests was carried out for the general SAQ, as well as it six subscales. Results: Departments that introduced “eGENA” app (Median 3,74, IQR 0,90) reported a significantly higher median SAQ (U (NeGENA = 6, Nnon eGENA = 14) = 70,0, z = 2,31, p = 0,02, r = 0,516) than their counterparts (Median 2,82, IQR 0,77) with significant differences in the dimensions teamwork climate, work satisfaction, perception of management and working conditions. Conclusion: Early adopters of cognitive aids are likely to show a significantly higher perception of safety culture in the SAQ. Consequently, successful implementation steps from these settings might not be sufficient in different clinics. Therefore, further investigation of the effects of safety culture on cognitive aid implementation should be conducted

Improved success rates using videolaryngoscopy in unexperienced users: a randomized crossover study in airway manikins

Background: Videolaryngoscopy has been proven to be a safe procedure managing difficult airways in the hands of airway specialists. Information about the success rates in unexperienced users of videolaryngoscopy compared to conventional laryngoscopy is sparse. Therefore, we aimed to evaluate if there might be more success in securing an airway if the unexperienced provider is using a videolaryngoscope in simulated airways in a randomized manikin study. Differences between commonly used videolaryngoscopes were elucidated. Methods: A standardized hands-on workshop prior to the study was performed. For direct laryngoscopy (DL) we used a Macintosh laryngoscope, whereas for videolaryngoscopy (VL) we used the cMac, the dBlade, and a King Vision videolaryngoscope. Endotracheal intubations in three simulated normal and difficult airways were performed. Main outcome parameters were time to view and time to intubation. Cormack and Lehane (C + L) classification and the percentage of glottic opening (POGO) score were evaluated. After every intubation, the participants were asked to review the airway and the device used. Results: 22 participants (14.8 +/- 4.0 intubations per year, mostly trauma surgeons) with limited experience in videolaryngoscopy (mean total number of videolaryngoscopy.4 +/- .2) were enrolled. We found improved C + L grades with VL in contrast to DL. We saw similar data with respect to the POGO score, where the participants achieved better visibility of the glottis with VL. The hyperangulated blade geometries of videolaryngoscopes provided a better visibility in difficult airways than the standard geometry of the Macintosh-type blade. The subjective performance of the VL devices was better in more difficult airway scenarios. Conclusions: After a short introduction and hands-on training, a videolaryngoscope seems to be safe and usable by unexperienced providers. We assume a standard geometry laryngoscope is optimal for a patient with normal anatomy, whereas VL device with a hyperangulated blade is ideal for difficult airway situations with limited mouth opening or restricted neck movement

„Entrustable professional activities“ für NotfallsanitäterInnen

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Hintergrund</jats:title> <jats:p>Wie in vielen medizinischen Berufen wird auch bei den NotfallsanitäterInnen (NotSan) der Kompetenzbegriff verwendet. Eine Möglichkeit, diese Kompetenz schrittweise entwickeln und messen zu können, steht aus. Ten Cate et al. schlagen hier das Konzept der „entrustable professional activities“ (EPA) vor. Ziel der Studie war, einen Katalog von relevanten Einsatzsituationen zu entwickeln, der die Grundlage für eine EPA-Integration in die Ausbildung ermöglicht.</jats:p> </jats:sec><jats:sec> <jats:title>Methode</jats:title> <jats:p>Die Erarbeitung des EPA-Katalogs erfolgte über ein 2‑stufiges Verfahren mittels webbasierter Fragebögen. Nach einer eDelphi-Analyse mit Praxisanleitenden im Rettungsdienst, wurden die Items in einem großen Kollektiv hinsichtlich der Relevanz validiert. Anschließend wurden Faktoren identifiziert und Skalen gebildet.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnisse</jats:title> <jats:p>Nach Validierung der Ergebnisse der eDelphi-Analyse ergaben sich fünf Skalen mit 22 Items. Sie umfassen die Bereiche „Behandlung spezieller Krankheitsbilder-NACA IV“, „Kommunikation“, „Einbinden von Medizinprodukten in die Patientenbehandlung“, „symptomorientiertes Handeln“ und „Leitsymptom Schmerz“. Die Items beschreiben 59 % der Gesamtvarianz und entsprechen einer stabilen Faktorenlösung.</jats:p> </jats:sec><jats:sec> <jats:title>Schlussfolgerung</jats:title> <jats:p>Es konnte ein Katalog von relevanten Einsatzsituationen in der NotSan-Ausbildung entwickelt werden, der sich zur weiteren Entwicklung von EPA eignet. Diese sollten flächendeckend und organisationsübergreifend einheitlich genutzt werden. Die Nutzung sollte didaktisch wissenschaftlich begleitet werden.</jats:p> </jats:sec&gt

Transfer of an interprofessional emergency caesarean section training program: using questionnaire combined with outcome data of newborn

Puprose!#!An emergency caesarean section is a potentially life-threatening situation both for the mother and the newborn. Non-technical skills can be improved by simulation training and are necessary to manage this urgent situation successfully. The objective of this study was to investigate, if training of emergency caesarean section can be transferred into daily work to improve the outcome parameters pH an APGAR of the newborn.!##!Methods!#!In this pre-post study, 141 professionals took part in a training for emergency caesarean section. Participants received a questionnaire, based on the tools 'Training Evaluation Inventory' and 'Transfer Climate Questionnaire' 1 year after training. Outcome data of the newborn were collected from the hospitals information system.!##!Results!#!Except the scale 'extinction', Cronbach's alpha was higher than 0.62. All scales were rated lower than 2.02 on a 5-point Likert Scale (1 = fullest approval; 5 = complete rejection). 'Negative reinforcement' was rated with 2.87 (SD 0.73). There were no significant differences in outcome data prior. The questionnaire fulfils criteria for application except the scale 'extinction'.!##!Conclusion!#!The presented training course was perceived as useful by the professionals and attitudes toward training were positive; the content was positively reinforced in practice 1 year after training. Parameters of the newborn did not change. It is conceivable that other outcome parameters (e.g. posttraumatic stress disorder) are addressed by the training. The development of relevant outcome parameters for the quality of emergency sections needs further investigation