The collaborative communication model for patient handover at the interface between high-acuity and low-acuity care

Background: Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events. Objectives: We analysed the communications between high-acuity and low-acuity units, their content and social context, and we explored whether common conceptual ground reduced potential threats to patient safety posed by current handover practices. Methods: We monitored the communication of five content items using handover probes for 22 patient transitions of care between high-acuity ' sender units' and low-acuity 'recipient units'. Data were analysed and discussed in focus groups with healthcare professionals to acquire insights into the characteristics of the common conceptual ground. Results: High-acuity and low-acuity units agreed about the presence of alert signs in the discharge form in 40% of the cases. The focus groups identified prehandover practices, particularly for anticipatory guidance that relied extensively on verbal phone interactions that commonly did not involve all members of the healthcare team, particularly nursing. Accessibility of information in the medical records reported by the recipient units was significantly lower than reported by sender units. Common ground to enable interpretation of the complete handover content items existed only among selected members of the healthcare team. Conclusions: The limited common ground reduced the likelihood of correct interpretation of important handover information, which may contribute to adverse events. Collaborative design and use of a shared set of handover content items may assist in creating common ground to enable clinical teams to communicate effectively to help increase the reliability and safety of cross-unit handovers

Some novel applications of VR in the domain of health

Recent progress in virtual reality (VR) technologies make immersion more accessible to everyone, and, in particular, developments aimed at the entertainment industry are being brought into to the domain of health. The main uses of VR in health are of two forms. First, it is a new method to diagnose and to treat patients; second, it is a new method to train and/or teach healthcare and emergency-response professionals. There are several reasons for using VR in healthcare. First, virtual environments (VE) are fully under control, so that the user (patient or professional) is then safe from any harm and the session can be interrupted if necessary. Second, there are many instances where placing the user in a real environment would be very hard to do and/or very costly. A major advantage of VR is that this user can instead be immerged in an equivalent artificial/virtual environment through the use of immersive technologies. Third, with regard to teaching, a significant advantage of VR is that it allows one “to bring the body to learning”, thereby effectively embedding new knowledge into the muscles. Below, we describe several uses of VR at our university in the domain of health. © Springer Nature Switzerland AG 2019

Beyond handover: supporting awareness for continuous coverage

Abstract Hospitals are required to operate as a continuous system because patient care cannot be temporarily suspended and handover is seen as a key method for enabling this. This paper reports a study of handover in a medical admissions unit. We draw on the notion of awareness as conceptualised within the Computer Supported Cooperative Work literature to explore the role played by a variety of cognitive artifacts in supporting continuous coverage. While such awareness is typically characterised as being ‘effortless’, our study reveals that maintaining awareness in a context such as the medical admissions unit is effortful due to invisible work. We suggest that the notion of awareness is beneficial for exploring the practices of continuous coverage because it moves attention away from the moment of handover, instead encouraging consideration of the variety of practices through which clinicians display their work to, and monitor the work of, colleagues on different shifts. We argue that efforts to support continuous coverage should focus on improving awareness by increasing the visibility of information

Making sense of health information technology implementation: A qualitative study protocol

BACKGROUND: Implementing new practices, such as health information technology (HIT), is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g., information exchange, communication, relationships) of providing care in hospitals. Thus, HIT implementation may occur slowly as staff members observe and make sense of unexpected disruptions in care. As a critical organizational function, sensemaking, defined as the social process of searching for answers and meaning which drive action, leads to unified understanding, learning, and effective problem solving -- strategies that studies have linked to successful change. Project teamwork is a change strategy increasingly used by hospitals that facilitates sensemaking by providing a formal mechanism for team members to share ideas, construct the meaning of events, and take next actions. METHODS: In this longitudinal case study, we aim to examine project teams' sensemaking and action as the team prepares to implement new information technology in a tiertiary care hospital. Based on management and healthcare literature on HIT implementation and project teamwork, we chose sensemaking as an alternative to traditional models for understanding organizational change and teamwork. Our methods choices are derived from this conceptual framework. Data on project team interactions will be prospectively collected through direct observation and organizational document review. Through qualitative methods, we will identify sensemaking patterns and explore variation in sensemaking across teams. Participant demographics will be used to explore variation in sensemaking patterns. DISCUSSION: Outcomes of this research will be new knowledge about sensemaking patterns of project teams, such as: the antecedents and consequences of the ongoing, evolutionary, social process of implementing HIT; the internal and external factors that influence the project team, including team composition, team member interaction, and interaction between the project team and the larger organization; the ways in which internal and external factors influence project team processes; and the ways in which project team processes facilitate team task accomplishment. These findings will lead to new methods of implementing HIT in hospitals

Unintended Transplantation of Three Organs from an HIV-Positive Donor: Report of the Analysis of an Adverse Event in a Regional Health Care Service in Italy

In February 2007, three organs from an human immunodeficiency virus (HIV)-positive donor were transplanted at two hospitals in the Tuscany Regional Health Care Service, owing to a chain of errors during the donation process. The heart-beating donor was a 41-year-old woman who died as a result of head trauma. The patient's history did not highlight any risky behavior. The available data on previous hospital admissions reported a negative result on HIV testing. During the donation process, the result of the lab test performed for evaluation of organ suitability was mistakenly transcribed from positive to negative. This wrong negative result was then included in the donation record without any cross-check. Therefore, the Regional Transplant Center allocated the liver and both kidneys. The patient also donated tissues, and a second laboratory conducted an evaluation of suitability for the tissue banks. During this process, only 5 days after the successful transplantation procedures, the positive HIV result was fed back to the Regional Transplant Center and the previous error discovered. Transplanted patients were immediately assessed and then treated with antiretroviral medications. A national commission soon performed a systems analysis of the adverse event. Besides the active error committed during the manual transcription for the HIV lab test result, the commission also identified technological factors, such as the lack of integration between the lab machine, the laboratory information system (LIS), and the donor record, as well as organizational factors, such as the distribution to two different labs of the suitability evaluation for organs and tissues. Recommendations included: automatic transmission of lab test results from the lab machine to the LIS and to the donor record, centralization of lab tests for suitability evaluation of organs and tissues, a training program to develop a proactive quality and safety culture in the regional network of donation and transplantations

Patient safety and Incident Reporting: the point of view of the Italian Healthcare Workers

Ergonomics and Safety Supplement for Quality and Safety in Healthcar

Safety and Quality of Maternal and Neonatal Pathway: Implementing the Modified WHO Safe Childbirth Checklist in Two Hospitals of Italy Through a Human Factor Approach

The use of tools to support the work of health professionals in managing clinical risk is widespread particularly in high-income countries. In 2008 the WHO designed a checklist for the safety and quality of care during childbirth. A multicentric study has been conducted by the Centre GRC of the Tuscany Region (Italy) with the aim of evaluating the impact of a modified version of the WHO checklist on clinical practice, through prospective pre- and post-intervention study based on clinical records review. Statistically significant differences (p <  .01) emerged regarding the frequency of the presence of a correctly completed partogram in the medical records, which were present in 61.9% of the cases in the pre-intervention group and in 75.3% of the cases in the post-intervention group. The mixed-effects logistic model revealed also a strong significant association between the checklist presence and the presence of a correctly completed partogram (OR = 3.1; 95% CI: 1.82–5.1)

Design for plus size people

Obesity is a growing issue in western societies with consequences for the field of human centered design. Most anthropometric data sources assume the data follow the Gaussian distribution, with population data symmetrically distributed above and below the mean value. This assumption is often true in length measurements like body heights, but may not be true for measurements more sensitive to body mass, like body weight, hip width, elbow-to-elbow width, and body depth. While length measurements have remained relatively stable over time in western societies, mass related measurements are increasing. The authors have experience in providing data via an interactive website DINED, which seeks to make anthropometry accessible without requiring expert knowledge about anatomy and statistics. Currently all DINED dimensions are assumed Gaussian, including those related to body mass. This might not work when designing for plus size people. Future additions in DINED will be about design for obesity and about how to implement 3D scanning into the design process in order to redress these defects.</p