Mobile phone text messaging intervention to improve alertness and reduce sleepiness and fatigue during shiftwork among emergency medicine clinicians: Study protocol for the SleepTrackTXT pilot randomized controlled trial

Background: Mental and physical fatigue while at work is common among emergency medical services (EMS) shift workers. Extended shifts (for example 24 hours) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management. Text message-based interventions are a potentially high-impact, low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue.Methods/Design: We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website. Participants will be allocated to one of two possible arms for a 90-day study period. The intervention arm will involve text message assessments of sleepiness, fatigue, and difficulty with concentration at the beginning, during, and end of scheduled shifts. Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork. Control subjects will receive assessment only text messages. We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention. We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers. Additional aims include testing whether a theory-based behavioral intervention, delivered by text message, changes 'alertness behaviors'.Discussion: The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms: 1) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers; or 2) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management services.Trial Registration: Clinicaltrials.gov NCT02063737, Registered on 10 January 2014. © 2014 Patterson et al

Network analysis of team communication in a busy emergency department

Background: The Emergency Department (ED) is consistently described as a high-risk environment for patients and clinicians that demands colleagues quickly work together as a cohesive group. Communication between nurses, physicians, and other ED clinicians is complex and difficult to track. A clear understanding of communications in the ED is lacking, which has a potentially negative impact on the design and effectiveness of interventions to improve communications. We sought to use Social Network Analysis (SNA) to characterize communication between clinicians in the ED. Methods. Over three-months, we surveyed to solicit the communication relationships between clinicians at one urban academic ED across all shifts. We abstracted survey responses into matrices, calculated three standard SNA measures (network density, network centralization, and in-degree centrality), and presented findings stratified by night/day shift and over time. Results: We received surveys from 82% of eligible participants and identified wide variation in the magnitude of communication cohesion (density) and concentration of communication between clinicians (centralization) by day/night shift and over time. We also identified variation in in-degree centrality (a measure of power/influence) by day/night shift and over time. Conclusions: We show that SNA measurement techniques provide a comprehensive view of ED communication patterns. Our use of SNA revealed that frequency of communication as a measure of interdependencies between ED clinicians varies by day/night shift and over time. © 2013 Patterson et al.; licensee BioMed Central Ltd

Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm

Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI

Early Septic Shock Care – Phenotypes and How We Got Here

Learning Objectives List three reasons for the ProCESS and other two non-US trials Note two main outcomes List two similarities in design and outcome with the more recent trials State how different sepsis phenotypes exist and could influence actions and assessment

Telehealth and Sepsis: Improving Access to High Quality Sepsis Care

This roundtable discussion will focus on how the use of real-time access to sepsis experts via a telemedicine network can decrease overall variation in care and improve clinical outcomes

Debates in Sepsis

Dr. Chanu Rhee - Brigham and Women’s Hospital, Harvard University Dr. Rhee is an Assistant Professor of Population Medicine at Harvard Medical School / Harvard Pilgrim Health Care Institute and an infectious disease and critical care physician at Brigham and Women\u27s Hospital. Dr. Rhee’s clinical and research interest is the epidemiology, diagnosis, treatment, and prevention of sepsis and infections in critically ill patients, with a particular focus on using electronic health record data to improve disease surveillance and quality of care. As the clinical co-lead for the Partners Sepsis Collaborative, he has been an institutional leader in ongoing efforts to improve sepsis recognition and management across the Partners HealthCare System. He is a member of the Massachusetts Sepsis Consortium and Emergency Sepsis Protocols Task Force that seeks to reduce sepsis morbidity and mortality across the Commonwealth. Nationally, Dr. Rhee is on the forefront of innovative research on sepsis surveillance and quality monitoring. As an investigator in the CDC Prevention Epicenters Program, he led a multicenter collaborative project that estimated the U.S. national burden of sepsis using electronic health record data from over 400 hospitals. This work led to the development of CDC’s Adult Sepsis Event surveillance definition that is being used to help hospitals objectively track their sepsis rates and outcomes and drive further innovations in care. Dr. Rhee has received grant funding from the CDC and is currently supported by a K08 career development award from the Agency for Healthcare Research and Quality. Dr. Donald Yealy - University of Pittsburgh Medical Center Dr. Yealy is Chair of the Department of Emergency Medicine at the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center Dr. Yealy has focused most of his research on clinical decision making and the early care of many life-threatening conditions, including community-acquired pneumonia, sepsis, acute heart failure and respiratory failure. Dr. Michael Leonard - Duke School of Medicine Michael Leonard, MD is an Adjunct Professor of Medicine, Duke University School of Medicine and a board certified anesthesiologist. Dr. Leonard received his medical degree from the University of Missouri School of Medicine and completed a medical residency in anesthesiology at Beth Israel Hospital in Boston, Massachusetts. He is the co-founder of Safe and Reliable Healthcare and spent 20 years with Kaiser Permanente, both as a practicing clinicial anesthesiologist and leader, and 10 years as the National Physician Leader for Patient Safety. In 1999, he helped Kaiser forge a collaborative relationship with Dr. Robert Helmreich’s Human Factors Research Project, to work on the application of human factors teamwork and communication training into healthcare. Dr. Leonard has a deep interest in culture, leadership, teamwork and reliability in diverse areas of clinical practice. He has taught extensively in high-risk areas such as surgery, obstetrics, critical care and others to enhance safety. He is a faculty member of the Institute for Healthcare Improvement.. Dr. Leonard recently collaborated on a third book on patient safety, The Essential Guide for Patient Safety Officers that was published by the Institute of Healthcare Improvement and the Joint Commission. He is also known for co-developing TeamSTEPPs; healthcare CRM; the Safety Attitudes Questionnaire [SAQ], which was the first culture assessment tool for healthcare; and its successor, the SCORE integrated survey; as well as The Mayo Clinic’s Team-based Engagement Model [TEM]. Dr. Cindy Hou - Jefferson Health New Jersey Cindy Hou, DO, is the Infection Control Officer at Jefferson Health New Jersey and is an infectious diseases specialist with Jefferson Health Infectious Diseases. Locally, she is the physician lead for the hospital’s Antimicrobial Stewardship Committee and Sepsis on the Floors Task Force. At the state level, she serves as the physician champion for the New Jersey Hospital Association’s Antimicrobial Stewardship Collaborative. She is a 2018 recipient of the Heroes of Infection Prevention award in Patient Safety from the Association of Professionals in Infection Control. Dr. Hou went to Yale University for her undergraduate studies, and also received her MA and MBA from Boston University, and D.O. from the University of New England College of Osteopathic Medicine. She is fellowed by the American College of Osteopathic Internists, the American College of Physicians, and the Infectious Diseases Society of America Dr. David Gaieski - Thomas Jefferson University David Gaieski, MD is an Associate Professor of Emergency Medicine, Vice Chair, Resuscitation Services, & Director of Emergency Critical Care in the Department of Emergency Medicine at Jefferson. His expertise and research interests are in optimal implementation of novel clinical care and large database analyses of severe sepsis patients and cardiac arrest patients. He lectures often on these topics both nationally and internationally. He attended the University of Pennsylvania School of Medicine, and completed his residency there in Emergency Medicine

Impact of advanced monitoring variables on intraoperative clinical decision-making: an international survey

To assess the relationship between the addition of advanced monitoring variables and changes in clinical decision-making. A 15-questions survey was anonymously emailed to international experts and physician members of five anesthesia societies which focused on assessing treatment decisions of clinicians during three realistic clinical scenarios measured at two distinct time points. The first is when typical case information and basic monitoring (T1) were provided, and then once again after the addition of advanced monitoring variables (T2). We hypothesized that the addition of advanced variables would increase the incidence of an optimal therapeutic decision (a priori defined as the answer with the highest percentage of expert agreement) and decrease the variability among the physician’s suggested treatments. The survey was completed by 18 experts and 839 physicians. Overall, adding advanced monitoring did not significantly increase physician response accuracy, with the least substantial changes noted on questions related to volume expansion or vasopressor administration. Moreover, advanced monitoring data did not significantly decrease the high level of initial practice variability in physician suggested treatments (P = 0.13), in contrast to the low variability observed within the expert group (P = 0.039). Additionally, 5–10 years of practice (P < 0.0001) and a cardiovascular subspecialty (P = 0.048) were both physician characteristics associated with a higher rate of optimal therapeutic decisions. The addition of advanced variables was of limited benefit for most physicians, further indicating the need for more in depth education on the clinical value and technical understanding of such variables.SCOPUS: ar.jinfo:eu-repo/semantics/publishe