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Schutte M, van Mansfeld R, de Vries R, Dekker M. Determinants of compliance with infection prevention measures by physicians: a scoping review. J Hosp Infect 2024; 153:30-38. [PMID: 39214255 DOI: 10.1016/j.jhin.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/05/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking. The aim of this review was to identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models, and frameworks from implementation science have been used in these studies. A literature search was performed in PubMed, Embase, APA PsycInfo and Web of Science up to June 2nd, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF). Fifty-six articles were included. The TDF domains 'environmental context and resources', 'social influences', 'beliefs about consequences', 'memory, attention and decision-making', 'knowledge', and 'skills' were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education, and a champion. Theories, models, and frameworks have rarely been used to guide implementation strategy development. In conclusion, it was found that intervention studies rarely specify the determinants that they aim to address and they lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.
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Affiliation(s)
- M Schutte
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - R van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - M Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Karam JA, Tokarski A, Deirmengian C, Thalody H, Kwan SA, Mccahon J, Lutz R, Courtney PM, Deirmengian GK. A Video Teaching Tool Is Effective for Training Residents in Hip Arthroplasty Templating. Cureus 2023; 15:e35856. [PMID: 37033582 PMCID: PMC10078669 DOI: 10.7759/cureus.35856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
Work hour restrictions imposed on orthopedic surgery residents since the early 2000s have reduced educational opportunities at the workplace and encouraged alternative strategies for teaching outside the clinical setting. Preoperative templating is essential for safe and effective total hip arthroplasty (THA) and is accurate in predicting final implants. We sought to determine the effectiveness of a video tool for teaching orthopedic residents basic THA templating skills. We developed a video-based teaching tool with instructions on proper THA templating techniques. Ten cases were selected for testing, after excluding patients with severe hip deformities and poor-quality radiographs and only retaining those with concordance between templating by the senior authors and implanted components. The study subjects included three postgraduate year 1 (PGY-1), three PGY-2, and three PGY-5 residents, and three adult reconstruction fellows (PGY-6). Templating skills were assessed before and after watching the instructional video. The evaluation included the size and positioning of femoral and acetabular components, as well as the restoration of leg length. Each templating session was repeated twice. Variance was measured to evaluate consistency in measurements. A linear mixed model and F-test were used for statistical analyses. The number of years in training significantly affected performance prior to exposure to the instructional video. Post-exposure, there was a significant improvement in the accuracy of sizing and positioning of acetabular and femoral components for PGY-1, PGY-2, and PGY-5 residents. The results achieved were comparable to PGY-6 examiners, who did not gain substantial performance benefits from the instructional video. Limb length restoration was less affected by experience or exposure to the video. Component positioning and sizing, as well as leg length discrepancy (LLD), showed a significant decrease in variance after the intervention in all study groups. Video learning is reliable in teaching invaluable skills to orthopedic surgery residents without encroaching on work hours. We conceived a concise video to train orthopedic residents to perform THA templating with proper technique and demonstrated its efficiency and reproducibility.
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Savage AJ, McNamara PW, Moncrieff TW, O'Reilly GM. Review article: E-learning in emergency medicine: A systematic review. Emerg Med Australas 2022; 34:322-332. [PMID: 35224870 PMCID: PMC9306619 DOI: 10.1111/1742-6723.13936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
E-learning (EL) has been developing as a medical education resource since the arrival of the internet. The COVID-19 pandemic has minimised clinical exposure for medical trainees and forced educators to use EL to replace traditional learning (TL) resources. The aim of this review was to determine the impact of EL versus TL on emergency medicine (EM) learning outcomes of medical trainees. A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement using articles sourced from CINAHL, Embase, OVID Medline and PubMed. Articles were independently reviewed by two reviewers following strict inclusion and exclusion criteria. Bias was assessed using the Cochrane Risk of Bias tool. The search yielded a total of 1586 non-duplicate studies. A total of 19 studies were included for data extraction. Fifteen of the included studies assessed knowledge gain of participants using multiple-choice questions as an outcome measure. Eleven of the 15 demonstrated no statistically significant difference while two studies favoured EL with statistical significance and two favoured TL with statistical significance. Six of the included studies assessed practical skill gain of participants. Five of the six demonstrated no statistical significance while one study favoured EL with statistical significance. This systematic review suggests that EL may be comparable to TL for the teaching of EM. The authors encourage the integration of EL as an adjunct to face-to-face teaching where possible in EM curricula; however, the overall low quality of evidence precludes definitive conclusions from being drawn.
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Affiliation(s)
| | | | | | - Gerard M O'Reilly
- Emergency and Trauma CentreThe AlfredMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- National Trauma Research InstituteThe AlfredMelbourneVictoriaAustralia
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Methodological and technical considerations for video-based auditing of hand hygiene compliance in clinical practice: an exploratory study. Am J Infect Control 2021; 49:1384-1391. [PMID: 33940065 DOI: 10.1016/j.ajic.2021.04.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Direct observation is the gold standard method for measuring hand hygiene compliance but its utility is increasingly being questioned. Various alternative electronic methods have been proposed, yet there is a paucity of research examining the use of these according to the World Health Organization's (WHO) '5 Moments for Hand Hygiene'. As a part of the process of developing a video-based monitoring system (VMS) capable of measuring hand hygiene compliance against the 5 moments criteria this paper reports methodological and technical issues that might arise from the use of a VMS for auditing in clinical practice. METHODS In-depth semi-structured interviews were conducted with 27 Australian content experts in hand hygiene auditing and infection prevention to explore their responses to proposed VMS auditing approaches. Transcripts were analyzed using thematic and content analysis. RESULTS Technical and methodological considerations for the use of VMS were interrelated and included concerns surrounding privacy, footage security, fears of surveillance and the potential for medico-legal consequences. Additionally, possible detrimental impacts on healthcare worker (HCW) -patient relationships, issues of cost versus benefits, HCW and patient safety and changes to feedback were also identified. CONCLUSIONS The primary methodological and technical issues to overcome in order to implement VMS for hand hygiene auditing in clinical practice, centered upon issues of acceptability to patients and health professionals, privacy, consent and liability. CHECKLIST COREQ.
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Mckay KJ, Shaban RZ, Ferguson P. Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future? Infect Dis Health 2020; 25:92-100. [PMID: 31932242 DOI: 10.1016/j.idh.2019.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
Hand hygiene is universally recognised as the primary measure to reduce healthcare-associated infections. Studies have convincingly demonstrated a link between increased hand hygiene compliance and reductions in rates of healthcare-associated infections. Direct observation is considered the gold standard method for monitoring hand hygiene compliance. Despite the acknowledged benefits of this approach, recent literature has highlighted a range of issues impacting on the reliability and validity of this data collection technique. The rise of technology in healthcare provides opportunity for alternative methods that promise advantages over direct human observation. There have been no published examples of systems that are able to capture data consistent with all the WHO '5 Moments for Hand Hygiene'. In this paper we explore current human-based auditing practises for monitoring hand hygiene compliance and raise for discussion and debate video-based technologies to monitor hand hygiene compliance. We raise questions regarding hybrid approaches that incorporate both direct human observation and indirect video-based surveillance, and the possible advantages and disadvantages therein for monitoring hand hygiene compliance. We suggest that such methods have the potential to ameliorate, or minimise, the inherent biases associated with direct observation, notably the Hawthorne Effect. Future research into the utility of a hybrid approach to auditing, including the technical specifications, efficacy, cost effectiveness and acceptability of such a model is warranted.
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Affiliation(s)
- Katherine J Mckay
- Infection Prevention and Control, Eastern Health, Box Hill, Victoria, Australia; Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Patricia Ferguson
- School of Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
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Altersberger M, Pavelka P, Sachs A, Weber M, Wagner-Menghin M, Prosch H. Student Perceptions of Instructional Ultrasound Videos as Preparation for a Practical Assessment. Ultrasound Int Open 2019; 5:E81-E88. [PMID: 31720557 PMCID: PMC6837857 DOI: 10.1055/a-1024-4573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/04/2019] [Accepted: 10/06/2019] [Indexed: 01/03/2023] Open
Abstract
Background Learning ultrasound early in the medical school curriculum
helps students to understand anatomy and pathology and to perform defined
ultrasound standard views. Instructional videos are a potentially valuable
tool for improving the process of learning ultrasound skills. It was the aim
of the present study to investigate how students perceived instructional
videos as a learning aid, compared to other learning opportunities, in
preparation for an Objective Structured Clinical Examination (OSCE). Materials and Methods
Eleven concise ultrasound videos were created
and implemented in the 4
th
year at the Medical University of
Vienna. The videos illustrate the predefined examination process, image
optimization, and nine standardized ultrasound views. The videos were
available to be used in preparation for the practical ultrasound
examination, which was part of the objective structured clinical
examination. The students’ perceptions of the instructional videos
and other learning methods were surveyed using an online questionnaire.
Results In total, 445 of 640 students (69.5% of the cohort)
used the instructional videos. Of those students, 134 (30%) answered
the questionnaire. Of this group, 88.9% rated the instructional
videos as very helpful (49.6% as extremely helpful). An ANOVA
revealed a significant difference between various learning materials in
terms of helpfulness. Post hoc analysis showed that instructional videos
were perceived as the second most helpful learning material after
“self-execution and feedback.” Conclusion The study revealed that students use instructional videos
frequently and appreciate them as an extra tool for effective studying.
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Affiliation(s)
- Martin Altersberger
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Teaching Center, Medical University of Vienna, Vienna, Austria
| | - Philipp Pavelka
- Teaching Center, Medical University of Vienna, Vienna, Austria
| | - Alexander Sachs
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Helmut Prosch
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
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George PP, Zhabenko O, Kyaw BM, Antoniou P, Posadzki P, Saxena N, Semwal M, Tudor Car L, Zary N, Lockwood C, Car J. Online Digital Education for Postregistration Training of Medical Doctors: Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e13269. [PMID: 30801252 PMCID: PMC6410118 DOI: 10.2196/13269] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
Background Globally, online and local area network–based (LAN) digital education (ODE) has grown in popularity. Blended learning is used by ODE along with traditional learning. Studies have shown the increasing potential of these technologies in training medical doctors; however, the evidence for its effectiveness and cost-effectiveness is unclear. Objective This systematic review evaluated the effectiveness of online and LAN-based ODE in improving practicing medical doctors’ knowledge, skills, attitude, satisfaction (primary outcomes), practice or behavior change, patient outcomes, and cost-effectiveness (secondary outcomes). Methods We searched seven electronic databased for randomized controlled trials, cluster-randomized trials, and quasi-randomized trials from January 1990 to March 2017. Two review authors independently extracted data and assessed the risk of bias. We have presented the findings narratively. We mainly compared ODE with self-directed/face-to-face learning and blended learning with self-directed/face-to-face learning. Results A total of 93 studies (N=16,895) were included, of which 76 compared ODE (including blended) and self-directed/face-to-face learning. Overall, the effect of ODE (including blended) on postintervention knowledge, skills, attitude, satisfaction, practice or behavior change, and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher postintervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge scores (small to large effect size and very low quality) for the intervention, while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size and low quality), while 13 studies reported no difference in the skill scores between the groups. One study reported a higher attitude score for the intervention (very low quality), while four studies reported no difference in the attitude score between the groups. Four studies reported higher postintervention physician satisfaction with the intervention (large effect size and low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher postintervention practice or behavior change for the ODE group (small to moderate effect size and low quality), while five studies reported no difference in practice or behavior change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects or cost-effectiveness of the interventions. Conclusions Empiric evidence showed that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training practicing physicians. Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning. The quality of the evidence in these studies was found to be very low for knowledge. Further high-quality randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Pradeep Paul George
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.,Joanna Briggs Institute, University of Adelaide, Adelaide, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Olena Zhabenko
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhone Myint Kyaw
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Panagiotis Antoniou
- Laboratory of Medical Physics, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Pawel Posadzki
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nakul Saxena
- Ophthalmology Team, Novartis, Singapore, Singapore
| | - Monika Semwal
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nabil Zary
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Learning, Informative, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,10I Emerging Technologies Lab, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Craig Lockwood
- Joanna Briggs Institute, University of Adelaide, Adelaide, Australia
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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A Novel Multimedia Workshop on Portable Cardiac Critical Care Ultrasonography: A Practical Option for the Busy Intensivist. Anaesth Intensive Care 2019; 40:838-43. [DOI: 10.1177/0310057x1204000511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Miller KA, Monuteaux MC, Aftab S, Lynn A, Hillier D, Nagler J. A Randomized Controlled Trial of a Video-Enhanced Advanced Airway Curriculum for Pediatric Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1858-1864. [PMID: 30095451 DOI: 10.1097/acm.0000000000002392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Pediatric advanced airway management is a low-frequency but critical procedure, making it challenging for trainees to learn. This study examined the impact of a curriculum integrating prerecorded videos of patient endotracheal intubations on performance related to simulated pediatric intubation. METHOD The authors conducted a randomized controlled educational trial for pediatric residents between January 2015 and June 2016 at Boston Children's Hospital. Investigators collecting data were blinded to the intervention. The control group received a standard didactic curriculum including still images, followed by simulation on airway trainers. The intervention group received a video-enhanced didactic curriculum including deidentified intubation clips recorded using a videolaryngoscope, followed by simulation. The study assessed intubation skills on simulated infant and pediatric airway scenarios of varying difficulty immediately after instruction and at three months. RESULTS Forty-nine trainees completed the curriculum: 23 received the video-enhanced curriculum and 26 received the standard curriculum. Median time to successful intubation was 18.5 and 22 seconds in the video-enhanced and standard groups, respectively. Controlling for mannequin age and difficulty, residents receiving the video-enhanced curriculum successfully intubated faster (hazard ratio [95% confidence interval]: 1.65 [1.25, 2.19]). Video-enhanced curriculum participants also demonstrated decreased odds of requiring multiple attempts and of esophageal intubation. At three-month follow-up, residents who received the video-enhanced curriculum remained faster at intubation (hazard ratio [95% confidence interval]: 1.93 [1.23, 3.02]). CONCLUSIONS Integrating videos of patient intubations into an airway management curriculum improved participating pediatric residents' intubation performance on airway trainers with sustained improvement at three months.
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Affiliation(s)
- Kelsey A Miller
- K.A. Miller is a fellow, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. M.C. Monuteaux is senior epidemiologist and biostatistician, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. S. Aftab is director, Fetal Care Center, Nicklaus Children's Hospital, Miami, Florida. A. Lynn is a medical student, Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona. D. Hillier is staff physician, Intermediate Care Program, Boston Children's Hospital, Boston, Massachusetts. J. Nagler is associate physician, Division of Emergency Medicine, and director, Pediatric Emergency Medicine Fellowship, Boston Children's Hospital, Boston, Massachusetts
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Development and Utilization of 3D Printed Material for Thoracotomy Simulation. Emerg Med Int 2018; 2018:9712647. [PMID: 30581626 PMCID: PMC6276476 DOI: 10.1155/2018/9712647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/18/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022] Open
Abstract
Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with EM residents at an inner city teaching hospital showed improved confidence. A total of 21 residents participated in each of the three surveys [(1) initially, (2) after watching the educational video, and (3) after participating in the simulation]. Their comfort levels increased from baseline after watching the educational video (9.5%). The comfort level further improved from baseline after performing the hands on simulation (71.4%).
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11
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Improved Compliance and Comprehension of a Surgical Safety Checklist With Customized Versus Standard Training: A Randomized Trial. J Patient Saf 2018; 14:138-142. [DOI: 10.1097/pts.0000000000000183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee PH, Fu B, Cai W, Chen J, Yuan Z, Zhang L, Ying X. The effectiveness of an on-line training program for improving knowledge of fire prevention and evacuation of healthcare workers: A randomized controlled trial. PLoS One 2018; 13:e0199747. [PMID: 29975723 PMCID: PMC6033414 DOI: 10.1371/journal.pone.0199747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/27/2018] [Indexed: 12/01/2022] Open
Abstract
Background Hospitals are vulnerable to fires and the evacuation process is challenging. However, face-to-face fire prevention and evacuation training may take healthcare workers’ time away from patient care; therefore, effective on-line training may be warranted. We carried out and examined the effectiveness of an on-line education and training of fire prevention and evacuation training for healthcare workers in China by a randomized controlled trial using convenience sampling from five public hospitals in China. Methods A total of 128 participants were recruited between December 2014 and March 2015. The authors built a webpage that included the informed consent statement, pre-test questionnaire, video training, and post-test questionnaire. After completing the pre-test questionnaire, participants were randomly assigned to watch the intervention video (basic response to a hospital fire) or the control video (introduction to volcanic disasters). A 45-item questionnaire on knowledge of fire prevention and evacuation was administered before and after the video watching. This questionnaire were further divided into two subscales (25-item generic knowledge of fire response and 20-item hospital-specific knowledge of fire prevention and evacuation). One point was awarded for each correct answer. Results Half of the participants (n = 64, 50%) were randomized into the intervention group and the remaining 64 (50%) were randomized into the control group. For generic knowledge of fire prevention and evacuation, those in the intervention group improved significantly (from 16.16 to 20.44, P < 0.001) while the scores of those in the control group decreased significantly (from 15.27 to 13.70, P = 0.03). For hospital-specific knowledge of fire prevention and evacuation, those in the intervention group (from 10.75 to 11.33, P = 0.15) and the control group (from 10.38 to 10.16, P = 0.54) had insignificant change. For total score, those in the intervention group improved significantly (from 26.91 to 31.77, P < 0.001) while those in the control group decreased insignificantly (from 25.64 to 23.86, P = 0.07). After the intervention, the difference between the scores of the intervention group and the control group on all three knowledge areas of fire prevention and evacuation (generic, hospital-specific, and total) were significant (all Ps < 0.05). Conclusions An on-line fire training program delivered via educational video can effectively improve healthcare workers’ knowledge of fire prevention and evacuation. Trial registration Clinicaltrials.gov NCT02438150
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Affiliation(s)
- Paul H. Lee
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
- * E-mail:
| | - Baoguo Fu
- Department of Disaster Nursing, Sichuan University—The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
- The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Wangting Cai
- Department of Disaster Nursing, Sichuan University—The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
| | - Jingya Chen
- Department of Disaster Nursing, Sichuan University—The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
| | - Zhenfei Yuan
- Department of Disaster Nursing, Sichuan University—The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
| | - Lifen Zhang
- Department of Disaster Nursing, Sichuan University—The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
| | - Xiuhong Ying
- Department of Disaster Nursing, Sichuan University—The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
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13
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Pilieci SN, Salim SY, Heffernan DS, Itani KMF, Khadaroo RG. A Randomized Controlled Trial of Video Education versus Skill Demonstration: Which Is More Effective in Teaching Sterile Surgical Technique? Surg Infect (Larchmt) 2018; 19:303-312. [PMID: 29406814 DOI: 10.1089/sur.2017.231] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Video education has many advantages over traditional education including efficiency, convenience, and individualized learning. Learning sterile surgical technique (SST) is imperative for medical students, because proper technique helps prevent surgical site infections (SSIs). We hypothesize that video education is at least as effective as traditional skill demonstration in teaching first-year medical students SST. METHODS A video series was created to demonstrate SST ( https://www.youtube.com/playlist?list=PLcRU-gvOmxE2mwMWkowouBkxGXkLZ8Uis ). A randomized controlled trial was designed to assess which education method best teaches SST: video education or skill demonstration. First-year medical students (n = 129) were consented and randomly assigned into two groups: those who attended a skill demonstration (control group; n = 70) and those who watched the video series (experimental group; n = 59). The control group attended a pre-existing 90-minute nurse educator-led skill demonstration. Participants then completed a 30-item multiple choice quiz to test their knowledge. Each group then received the alternate education method and completed a 23-item follow-up survey to determine their preferred method. RESULTS Seven 2- to 6-minute videos (30 minutes total) were created on surgical attire, scrubbing, gowning and gloving, and maintaining sterility. The experimental group (n = 51) scored higher on the quiz compared with the control group (n = 63) (88% ± 1% versus 72% ± 1%; p < 0.0001). Students preferred the videos when it came to convenience, accessibility, efficiency, and review, and preferred the skill demonstration when it came to knowledge retention, preparedness, and ease of completion. CONCLUSIONS Video education is superior to traditional skill demonstration in providing medical students with knowledge of SST. Students identified strengths to each method of teaching. Video education can augment medical students' knowledge prior to their operating room experience to ensure that a sterile environment is maintained for patients. The ultimate goal is to reduce SSIs.
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Affiliation(s)
- Stephanie N Pilieci
- 1 Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - Saad Y Salim
- 2 Department of Surgery, University of Alberta , Edmonton, Alberta, Canada
| | | | - Kamal M F Itani
- 4 Veterans Health Administration , Surgical Service, Boston, Massachusetts
| | - Rachel G Khadaroo
- 5 Department of Surgery and Critical Care Medicine, University of Alberta , Edmonton, Alberta, Canada
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Vankipuram A, Vankipuram M, Ghaemmaghami V, Patel VL. A mobile application to support collection and analytics of real-time critical care data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 151:45-55. [PMID: 28947005 DOI: 10.1016/j.cmpb.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Data collection, in high intensity environments, poses several challenges including the ability to observe multiple streams of information. These problems are especially evident in critical care, where monitoring of the Advanced Trauma Life Support (ATLS) protocol provides an excellent opportunity to study the efficacy of applications that allow for the rapid capture of event information, providing theoretically-driven feedback using the data. Our goal was, (a) to design and implement a way to capture data on deviation from the standard practice based on the theoretical foundation of error classification from our past research, (b) to provide a means to meaningfully visualize the collected data, and (c) to provide a proof-of-concept for this implementation, using some understanding of user experience in clinical practice. METHODS We present the design and development of a web application designed to be used primarily on mobile devices and a summary data viewer to allow clinicians to, (a) track their activities, (b) provide real-time feedback of deviations from guidelines and protocols, and (c) provide summary feedback highlighting decisions made. We used a framework previously developed to classify activities in trauma as the theoretical foundation of the rules designed to do the same algorithmically, in our application. Attending physicians at a Level 1 trauma center used the application in the clinical setting and provided feedback for iterative development. Informal interviews and surveys were used to gain some deeper understanding of the user experience using this application in-situ. RESULTS Activity visualizations were created highlighting decisions made during a trauma code as well as classification of tasks per the theoretical framework. The attendings reviewed the efficacy of the data visualizations as part of their interviews. We also conducted a proof-of-concept evaluation by way of usability questionnaire. Two attendings rated 4 out of the usability 6 categories highly (inter-rater reliability: R = 0.87; weighted kappa = 0.59). This could be attributed to the fact that they were able to fit the use of the application into their regular workflow during a trauma code relatively seamlessly. A deeper evaluation is required to answer explain this further. CONCLUSIONS Our application can be used to capture and present data to provide an accurate reflection of work activities in real-time in complex critical care environments, without any significant interruptions to workflow.
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Affiliation(s)
- Akshay Vankipuram
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA.
| | | | - Vafa Ghaemmaghami
- Abrazo West Campus, Abrazo Community Health Network, Goodyear, AZ, USA.
| | - Vimla L Patel
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, USA; Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY, USA.
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Brydges R, Stroud L, Wong BM, Holmboe ES, Imrie K, Hatala R. Core Competencies or a Competent Core? A Scoping Review and Realist Synthesis of Invasive Bedside Procedural Skills Training in Internal Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1632-1643. [PMID: 28489618 DOI: 10.1097/acm.0000000000001726] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training. METHOD The authors systematically searched Medline, Embase, the Cochrane Library, and ERIC through April 2015. Studies were screened in three phases; all reviews were performed independently and in duplicate. The authors extracted information on learner and patient demographics, study design and methodological quality, and details of training interventions and measured outcomes. A three-step realist synthesis was performed to synthesize findings on each study's context, mechanism, and outcome, and to identify a foundational training model. RESULTS From an initial 6,671 studies, 149 studies were further reduced to 67 (45%) reporting sufficient information for realist synthesis. Analysis yielded four types of procedural skills training interventions. There was relative consistency across contexts and significant differences in mechanisms and outcomes across the four intervention types. The medical procedural service was identified as an adaptable foundational training model. CONCLUSIONS The observed heterogeneity in procedural skills training implies that programs are not consistently developing residents who are competent in core procedures. The findings suggest that researchers in education and quality improvement will need to collaborate to design training that develops a "competent core" of proceduralists using simulation and clinical rotations.
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Affiliation(s)
- Ryan Brydges
- R. Brydges is assistant professor, Department of Medicine, University of Toronto, and scientist, Wilson Centre, University Health Network, Toronto, Ontario, Canada. L. Stroud is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. B.M. Wong is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. K. Imrie is immediate past president, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. R. Hatala is associate professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Khandelwal A, Devine LA, Otremba M. Quality of Widely Available Video Instructional Materials for Point-of-Care Ultrasound-Guided Procedure Training in Internal Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1445-1452. [PMID: 28370388 DOI: 10.7863/ultra.16.06059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Many instructional materials for point-of-care ultrasound (US)-guided procedures exist; however, their quality is unknown. This study assessed widely available educational videos for point-of-care US-guided procedures relevant to internal medicine: central venous catheterization, thoracentesis, and paracentesis. METHODS We searched Ovid MEDLINE, YouTube, and Google to identify videos for point-of-care US-guided paracentesis, thoracentesis, and central venous catheterization. Videos were evaluated with a 5-point scale assessing the global educational value and a checklist based on consensus guidelines for competencies in point-of-care US-guided procedures. RESULTS For point-of-care US-guided central venous catheterization, 12 videos were found, with an average global educational value score ± SD of 4.5 ± 0.7. Indications to abort the procedure were discussed in only 3 videos. Five videos described the indications and contraindications for performing central venous catheterization. For point-of-care US-guided thoracentesis, 8 videos were identified, with an average global educational value score of 4.0 ± 0.9. Only one video discussed indications to abort the procedure, and 3 videos discussed sterile technique. For point-of-care US-guided paracentesis, 7 videos were included, with an average global educational value score of 4.1 ± 0.9. Only 1 video discussed indications to abort the procedure, and 2 described the location of the inferior epigastric artery. CONCLUSIONS The 27 videos reviewed contained good-quality general instruction. However, we noted a lack of safety-related information in most of the available videos. Further development of resources is required to teach internal medicine trainees skills that focus on the safety of point-of-care US guidance.
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Affiliation(s)
- Aditi Khandelwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Luke A Devine
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mirek Otremba
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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Development and Assessment of an Advanced Pediatric Airway Management Curriculum With Integrated Intubation Videos. Pediatr Emerg Care 2017; 33:239-244. [PMID: 27383403 DOI: 10.1097/pec.0000000000000777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Opportunities to learn advanced airway management skills on pediatric patients in the emergency department are limited. Current strategies have focused largely on traditional didactics coupled with procedural skills training using simulation. However, these approaches are limited in their exposure to anatomic variation and realism. Here, we describe the development and assessment of an advanced airway curriculum that integrates videolaryngoscopic recordings obtained during actual patient intubations into a series of interactive educational sessions. METHODS Trainees and attending physicians were surveyed anonymously to assess the impact of participation in the curriculum. A mixed methods approach to statistical analysis was used. Rating questions were used to evaluate the relative impact of this approach over other traditional strategies and recurrent themes within open-ended questions were identified. RESULTS Participants reported this to be a highly effective means of learning about pediatric laryngoscopy and endotracheal intubation and regarded it more highly than other traditional educational approaches. Identified benefits included repetitive exposure, approaches to laryngoscopy, the realism of teaching using real and varied anatomy, and the opportunities to identify and troubleshoot difficulty in a learning environment. CONCLUSIONS An advanced pediatric airway curriculum that integrates intubation videos obtained during videolaryngoscopy was highly regarded by pediatric emergency medicine providers. Content emphasis can be shifted to meet the needs of pediatric emergency medicine providers with all levels of skill and experience.
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Takashima M, Ray-Barruel G, Ullman A, Keogh S, Rickard CM. Randomized controlled trials in central vascular access devices: A scoping review. PLoS One 2017; 12:e0174164. [PMID: 28323880 PMCID: PMC5360326 DOI: 10.1371/journal.pone.0174164] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/03/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Randomized controlled trials evaluate the effectiveness of interventions for central venous access devices, however, high complication rates remain. Scoping reviews map the available evidence and demonstrate evidence deficiencies to focus ongoing research priorities. METHOD A scoping review (January 2006-December 2015) of randomized controlled trials evaluating the effectiveness of interventions to improve central venous access device outcomes; including peripherally inserted central catheters, non-tunneled, tunneled and totally implanted venous access catheters. MeSH terms were used to undertake a systematic search with data extracted by two independent researchers, using a standardized data extraction form. RESULTS In total, 178 trials were included (78 non-tunneled [44%]; 40 peripherally inserted central catheters [22%]; 20 totally implanted [11%]; 12 tunneled [6%]; 6 non-specified [3%]; and 22 combined device trials [12%]). There were 119 trials (68%) involving adult participants only, with 18 (9%) pediatric and 20 (11%) neonatal trials. Insertion-related themes existed in 38% of trials (67 RCTs), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%). There were 46 different study outcomes reported, with the most common being infection outcomes (161 outcomes; 37%), with divergent definitions used for catheter-related bloodstream and other infections. CONCLUSION More high quality randomized trials across central venous access device management are necessary, especially in dressing and securement and patency. These can be encouraged by having more studies with multidisciplinary team involvement and consumer engagement. Additionally, there were extensive gaps within population sub-groups, particularly in tunneled devices, and in pediatrics and neonates. Finally, outcome definitions need to be unified for results to be meaningful and comparable across studies.
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Affiliation(s)
- Mari Takashima
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Samantha Keogh
- School of Nursing & Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Joyce MF, Berg S, Bittner EA. Practical strategies for increasing efficiency and effectiveness in critical care education. World J Crit Care Med 2017; 6:1-12. [PMID: 28224102 PMCID: PMC5295164 DOI: 10.5492/wjccm.v6.i1.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/30/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023] Open
Abstract
Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.
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Maertens H, Madani A, Landry T, Vermassen F, Van Herzeele I, Aggarwal R. Systematic review of e-learning for surgical training. Br J Surg 2016; 103:1428-37. [PMID: 27537708 DOI: 10.1002/bjs.10236] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/25/2016] [Accepted: 05/18/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. Despite widespread use, there is limited evidence to support their effectiveness for surgical training. This study sought to evaluate the effectiveness of e-learning as a teaching tool compared with no intervention and other methods of surgical training. METHODS A systematic literature search of bibliographical databases was performed up to August 2015. Studies were included if they were RCTs assessing the effectiveness of an e-learning platform for teaching any surgical skill, compared with no intervention or another method of training. RESULTS From 4704 studies screened, 87 were included with 7871 participants enrolled, comprising medical students (52 studies), trainees (51 studies), qualified surgeons (2 studies) and nurses (6 studies). E-learning tools were used for teaching cognitive (71 studies), psychomotor (36 studies) and non-technical (8 studies) skills. Tool features included multimedia (84 studies), interactive learning (60 studies), feedback (27 studies), assessment (26 studies), virtual patients (22 studies), virtual reality environment (11 studies), spaced education (7 studies), community discussions (2 studies) and gaming (2 studies). Overall, e-learning showed either greater or similar effectiveness compared with both no intervention (29 and 4 studies respectively) and non-e-learning interventions (29 and 22 studies respectively). CONCLUSION Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training.
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Affiliation(s)
- H Maertens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - A Madani
- Department of Surgery, McGill University, Montreal, Canada
| | - T Landry
- Montreal General Hospital Medical Library, McGill University Health Centre, Montreal, Canada
| | - F Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - I Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - R Aggarwal
- Department of Surgery, McGill University, Montreal, Canada.,Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, Canada
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21
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Melchiors J, Todsen T, Konge L, Charabi B, von Buchwald C. Cricothyroidotomy - The emergency surgical airway. Head Neck 2016; 38:1129-31. [DOI: 10.1002/hed.24392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/22/2015] [Accepted: 12/17/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jacob Melchiors
- Department of Otorhinolaryngology, Head and Neck Surgery, Centre of Head and Orthopedics, Rigshospitalet; University Hospital of Copenhagen; Denmark
| | - Tobias Todsen
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark; Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark; Copenhagen Denmark
| | - Birgitte Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery, Centre of Head and Orthopedics, Rigshospitalet; University Hospital of Copenhagen; Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, Centre of Head and Orthopedics, Rigshospitalet; University Hospital of Copenhagen; Denmark
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Huang GC, McSparron JI, Balk EM, Richards JB, Smith CC, Whelan JS, Newman LR, Smetana GW. Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches. BMJ Qual Saf 2015; 25:281-94. [PMID: 26543067 DOI: 10.1136/bmjqs-2014-003518] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/13/2015] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Optimal approaches to teaching bedside procedures are unknown. OBJECTIVE To identify effective instructional approaches in procedural training. DATA SOURCES We searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014. STUDY SELECTION We included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data from full-text articles. MAIN OUTCOMES AND MEASURES We included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as 'negative' or 'positive' based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes. RESULTS We found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p<0.001) were effective forms of training. CONCLUSIONS AND RELEVANCE This systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).
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Affiliation(s)
- Grace C Huang
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jakob I McSparron
- Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA Division of Pulmonary and Critical Care, Department of Medicine, Beth Israel Deaconess Medical, Center
| | - Ethan M Balk
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jeremy B Richards
- Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - C Christopher Smith
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia S Whelan
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori R Newman
- Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gerald W Smetana
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Hoskote SS, Khouli H, Lanoix R, Rose K, Aqeel A, Clark M, Chalfin D, Shapiro J, Han Q. Simulation-based training for emergency medicine residents in sterile technique during central venous catheterization: impact on performance, policy, and outcomes. Acad Emerg Med 2015; 22:81-7. [PMID: 25556399 DOI: 10.1111/acem.12551] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Central line-associated bloodstream infection (CLABSI) is a preventable nosocomial infection. Simulation-based training in sterile technique during central venous catheter (CVC) placement for emergency medicine (EM) residents, and its effect on changing the medical intensive care unit (MICU) practice of routine replacement of CVCs placed under sterile technique in the emergency department (ED), has not been evaluated. METHODS Emergency medicine residents received simulation-based sterile technique training during CVC placement between May 2008 and September 2010. Between June 2008 and January 2011, the authors reviewed records of patients who had CVCs placed in the ED under sterile technique by EM residents and were admitted to the MICU (group 1) and CVCs placed in the MICU under sterile technique by internal medicine (IM) residents (group 2). IM residents completed similar simulation-based training before May 2008. Changes in EM residents' sterile technique performance scores were compared, as well as CLABSI rates in both groups. EM residents' CVC procedural skills were not assessed. RESULTS Seventy-six EM residents completed simulation-based training with significant improvement in performance (median scores 13 out of 24 before training, 24 out of 24 after training; p < 0.001). CLABSI rates per 1,000 catheter-days were 1.02 in group 1 and 1.02 in group 2 (p = 0.99). Both groups had similar demographics, acuity, and mortality (p > 0.5). CONCLUSIONS Routine replacement of CVCs placed in the ED under sterile technique after simulation-based training would appear to be unnecessary. These findings demonstrate patient-centered outcomes that are comparable for CVCs in ED-admitted MICU patients, regardless of whether the CVC was placed in the ED or MICU.
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Affiliation(s)
- Sumedh S. Hoskote
- Department of Medicine; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
- Department of Medicine; Division of Pulmonary and Critical Care Medicine; Mayo Clinic; Rochester MN
| | - Hassan Khouli
- Section of Critical Care; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Richard Lanoix
- Department of Emergency Medicine; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Keith Rose
- Section of Critical Care; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Adnan Aqeel
- Department of Medicine; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Mark Clark
- Department of Emergency Medicine; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Donald Chalfin
- Section of Critical Care; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Janet Shapiro
- Section of Critical Care; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
| | - Qifa Han
- Section of Critical Care; St. Luke's-Roosevelt Hospital Center; Mount Sinai Health System; New York NY
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Liang SY, Theodoro DL, Schuur JD, Marschall J. Infection prevention in the emergency department. Ann Emerg Med 2014; 64:299-313. [PMID: 24721718 PMCID: PMC4143473 DOI: 10.1016/j.annemergmed.2014.02.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/01/2023]
Abstract
Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to health care personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, health care personnel vaccination, and environmental controls to strategies for preventing health care-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care.
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Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Daniel L Theodoro
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Carter EJ, Pouch SM, Larson EL. Common infection control practices in the emergency department: a literature review. Am J Infect Control 2014; 42:957-62. [PMID: 25179326 PMCID: PMC4340698 DOI: 10.1016/j.ajic.2014.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a major health concern, despite being largely avoidable. The emergency department (ED) is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline-based infection prevention practices. METHODS The purpose of this review was to examine published literature regarding adherence rates among ED personnel to selected infection control practices, including hand hygiene (HH) and aseptic technique during the placement of central venous catheters and urinary catheters. We also reviewed studies reporting rates of ED equipment contamination. PubMed was searched for studies that included adherence rates among ED personnel to HH during routine patient care, aseptic technique during the placement of central venous catheters and urinary catheters, and rates of equipment contamination. RESULTS In total, 853 studies was screened, and 589 abstracts were reviewed. The full texts of 36 papers were examined, and 23 articles were identified as meeting inclusion criteria. Eight studies used various scales to measure HH compliance, which ranged from 7.7% to 89.7%. Seven articles examined central venous catheters inserted in the ED or by emergency medicine residents. Detail of aseptic technique practices during urinary catheterization was lacking. Four papers described equipment contamination in the ED. CONCLUSION Standardized methods and definitions of compliance monitoring are needed to compare results across settings.
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Affiliation(s)
| | - Stephanie M Pouch
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Elaine L Larson
- School of Nursing, Columbia University, New York, NY; Mailman School of Public Health, Columbia University, New York, NY
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The development of an internet-based knowledge exchange platform for pediatric critical care clinicians worldwide*. Pediatr Crit Care Med 2014; 15:197-205. [PMID: 24395000 DOI: 10.1097/pcc.0000000000000051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Advances in Internet technology now enable unprecedented global collaboration and collective knowledge exchange. Up to this time, there have been limited efforts to use these technologies to actively promote knowledge exchange across the global pediatric critical care community. To develop an open-access, peer-reviewed, not-for-profit Internet-based learning application, OPENPediatrics, a collaborative effort with the World Federation of Pediatric Intensive and Critical Care Societies, was designed to promote postgraduate educational knowledge exchange for physicians, nurses, and others caring for critically ill children worldwide. DESIGN Description of program development. SETTING International multicenter tertiary pediatric critical care units across six continents. SUBJECTS Multidisciplinary pediatric critical care providers. INTERVENTIONS A software application, providing information on demand, curricular pathways, and videoconferencing, downloaded to a local computer. MEASUREMENTS AND MAIN RESULTS In 2010, a survey assessing postgraduate educational needs was distributed through World Federation of Pediatric Intensive and Critical Care Societies to constituent societies. Four hundred and twenty-nine critical care providers from 49 countries responded to the single e-mail survey request. Respondents included 68% physicians and 28% nurses who care for critically ill children. Fifty-two percent of respondents reported accessing the Internet at least weekly to obtain professional educational information. The five highest requests were for educational content on respiratory care [mechanical ventilation] (48% [38%]), sepsis (28%), neurology (25%), cardiology (14%), extracorporeal membrane oxygenation (10%), and ethics (8%). Based on these findings, and in collaboration with researchers in adult learning and online courseware, an application was developed and is currently being used by 770 registered users in 60 countries. CONCLUSIONS We describe here the development and implementation of an Internet-based application which is among the first efforts designed to promote global knowledge exchange for physicians and nurses caring for critically ill children. This application has the potential to evolve new methods in postgraduate education. Ongoing assessment of the efficacy of Internet-based learning platforms will be necessary.
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Ma IW, Sharma N, Brindle ME, Caird J, McLaughlin K. Measuring competence in central venous catheterization: a systematic-review. SPRINGERPLUS 2014; 3:33. [PMID: 24505556 PMCID: PMC3909608 DOI: 10.1186/2193-1801-3-33] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/14/2014] [Indexed: 11/13/2022]
Abstract
Objectives Central venous catheterization is a complex procedural skill. This study evaluates existing published tools on this procedure and systematically summarizes key competencies for the assessment of this technical skill. Methods Using a previously published meta-analysis search strategy, we conducted a systematic review of published assessment tools using the electronic databases PubMed, MEDLINE, Education Resource Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica, and Cochrane Central Register of Controlled Trials. Two independent investigators abstracted information on tool content and characteristics. Results Twenty-five studies were identified assessing a total of 147 items. Tools used for assessment at the bedside (clinical tools) had a higher % of items representing “preparation” and “infection control” than tools used for assessment using simulation (67 ± 26% vs. 32 ± 26%; p = 0.003 for “preparation” and 60 ± 41% vs. 11 ± 17%; p = 0.002 for “infection control”, respectively). Simulation tools had a higher % of items on “procedural competence” than clinical tools (60 ± 36% vs. 17 ± 15%; p = 0.002). Items in the domains of “Team working” and “Communication and working with the patient” were frequently under-represented. Conclusion This study presents a comprehensive review of existing checklist items for the assessment of central venous catheterization. Although many key competencies are currently assessed by existing published tools, some domains may be under-represented by select tools. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-33) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irene Wy Ma
- Department of Medicine, University of Calgary, Calgary, AB Canada ; W21C, University of Calgary, 3330 Hospital Dr NW, T2N 4N1 Calgary, AB Canada
| | - Nishan Sharma
- W21C, University of Calgary, 3330 Hospital Dr NW, T2N 4N1 Calgary, AB Canada
| | - Mary E Brindle
- Department of Surgery, University of Calgary, Calgary, AB Canada
| | - Jeff Caird
- W21C, University of Calgary, 3330 Hospital Dr NW, T2N 4N1 Calgary, AB Canada
| | - Kevin McLaughlin
- Department of Medicine, University of Calgary, Calgary, AB Canada
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Labeau SO. Is there a place for e-learning in infection prevention? Aust Crit Care 2013; 26:167-72. [PMID: 24183831 DOI: 10.1016/j.aucc.2013.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 10/03/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the last few decades, e-learning, a method which integrates information technology and the learning process by using materials delivered through the internet, has become widely used in educational initiatives for healthcare professionals. PURPOSE To evaluate whether there is a place for e-learning in the field of infection prevention. METHODS Non-comprehensive review of the literature. FINDINGS E-learning courses in the field of infection prevention and control are still scarce, often restricted to local initiatives and not specifically directed toward critical care providers. Although methodological flaws and potential biases hamper the generalizability of results from some currently available studies, findings related to both learners' satisfaction and effectiveness suggest that e-learning might prove an effective educational tool for the (continuing) education of healthcare providers. Further investigations, including research pertaining to the cost-effectiveness of e-learning, are required to provide a better insight in these issues. CONCLUSION Further research is required to determine the (cost)effectiveness of e-learning in general, and in the field of infection prevention and control in particular. Current insights suggest that e-learning should be based Web 2.0 technologies to address a wide range of learning styles and to optimize interactivity. As a gap in the literature was detected with respect to e-learning modules on infection prevention and control which are specifically oriented toward critical care providers, it can be recommended to promote the development and subsequent assessment of such tools that meet high-quality standards.
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Affiliation(s)
- Sonia O Labeau
- Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium.
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Sekiguchi H, Bhagra A, Gajic O, Kashani KB. A general Critical Care Ultrasonography workshop: results of a novel Web-based learning program combined with simulation-based hands-on training. J Crit Care 2013; 28:217.e7-12. [DOI: 10.1016/j.jcrc.2012.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 03/20/2012] [Accepted: 04/01/2012] [Indexed: 10/28/2022]
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Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database Syst Rev 2013:CD006559. [PMID: 23543545 DOI: 10.1002/14651858.cd006559.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators), and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. There are specific risk profiles for each device, but in general, the breakdown of aseptic technique during insertion and care for the device, as well as the duration of device use, are important factors for the development of these serious and costly infections. OBJECTIVES To assess the effectiveness of different interventions, alone or in combination, which target healthcare professionals or healthcare organisations to improve professional adherence to infection control guidelines on device-related infection rates and measures of adherence. SEARCH METHODS We searched the following electronic databases for primary studies up to June 2012: the Cochrane Effective Paractice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. We searched reference lists and contacted authors of included studies. We also searched the Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effectiveness (DARE) for related reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies that complied with the Cochrane EPOC Group methodological criteria, and that evaluated interventions to improve professional adherence to guidelines for the prevention of device-related infections. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of each included study using the Cochrane EPOC 'Risk of bias' tool. We contacted authors of original papers to obtain missing information. MAIN RESULTS We included 13 studies: one cluster randomised controlled trial (CRCT) and 12 ITS studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards, and more than 3504 patients and 1406 healthcare professionals. Six of the included studies targeted adherence to guidelines to prevent central line-associated blood stream infections (CLABSIs); another six studies targeted adherence to guidelines to prevent ventilator-associated pneumonia (VAP), and one study focused on interventions to improve urinary catheter practices. We judged all included studies to be at moderate or high risk of bias.The largest median effect on rates of VAP was found at nine months follow-up with a decrease of 7.36 (-10.82 to 3.14) cases per 1000 ventilator days (five studies and 15 sites). The one included cluster randomised controlled trial (CRCT) observed, improved urinary catheter practices five weeks after the intervention (absolute difference 12.2 percentage points), however, the statistical significance of this is unknown given a unit of analysis error. It is worth noting that N = 6 interventions that did result in significantly decreased infection rates involved more than one active intervention, which in some cases, was repeatedly administered over time, and further, that one intervention involving specialised oral care personnel showed the largest step change (-22.9 cases per 1000 ventilator days (standard error (SE) 4.0), and also the largest slope change (-6.45 cases per 1000 ventilator days (SE 1.42, P = 0.002)) among the included studies. We attempted to combine the results for studies targeting the same indwelling medical device (central line catheters or mechanical ventilators) and reporting the same outcomes (CLABSI and VAP rate) in two separate meta-analyses, but due to very high statistical heterogeneity among included studies (I(2) up to 97%), we did not retain these analyses. Six of the included studies reported post-intervention adherence scores ranging from 14% to 98%. The effect on rates of infection were mixed and the effect sizes were small, with the largest median effect for the change in level (interquartile range (IQR)) for the six CLABSI studies being observed at three months follow-up was a decrease of 0.6 (-2.74 to 0.28) cases per 1000 central line days (six studies and 36 sites). This change was not sustained over longer follow-up times. AUTHORS' CONCLUSIONS The low to very low quality of the evidence of studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions involving more than one active element and that are repeatedly administered over time, and interventions employing specialised personnel, who are focused on an aspect of care that is supported by evidence e.g. dentists/dental auxiliaries performing oral care for VAP prevention.
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Affiliation(s)
- Gerd Flodgren
- Department of Public Health, University of Oxford, Oxford, UK.
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Todsen T, Henriksen MV, Kromann CB, Konge L, Eldrup J, Ringsted C. Short- and long-term transfer of urethral catheterization skills from simulation training to performance on patients. BMC MEDICAL EDUCATION 2013; 13:29. [PMID: 23433258 PMCID: PMC3598217 DOI: 10.1186/1472-6920-13-29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/21/2013] [Indexed: 05/11/2023]
Abstract
BACKGROUND Inexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC simulated skills training on performance on real patients and to examine whether watching a video of the procedure immediately before assessment enhanced clinical performance. METHODS This was an experimental study of the effect of a UC simulation-based skills course on medical students' short-term (after one week) and long-term (after six weeks) performance. The additional effect of video instruction before performance testing on real patients was studied in a randomized trial. Sixty-four students participated in the study, which was preceded by a pilot study investigating the validity aspects of a UC assessment form. RESULTS The pilot study demonstrated sufficient inter-rater reliability, intra-class correlation coefficient 0.86, and a significant ability to discriminate between trainee performances when using the assessment form, p= 0.001. In the main study, more than 90% of students demonstrated an acceptable performance or better when tested on real patients. There was no significant difference in the total score between the one-week and the six-week groups when tested on real patients and no significant difference between the video and the control groups. CONCLUSIONS Medical students demonstrated good transfer of UC skills learned in the skills lab to real clinical situations up to six weeks after training. Simulated UC training should be the standard for all medical school curricula to reduce avoidable complications. However, this study did not demonstrate that an instructional video, as a supplement to simulated skills training, improved clinical UC performance. TRIAL REGISTRATION Current Controlled Trials ISRCTN:ISRCTN90745002.
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Affiliation(s)
- Tobias Todsen
- Centre for Clinical Education, University of Copenhagen and The Capital Region of Denmark, Rigshospitalet Afsnit 5404, Teilumbygningen,Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark
| | - Mikael V Henriksen
- Centre for Clinical Education, University of Copenhagen and The Capital Region of Denmark, Rigshospitalet Afsnit 5404, Teilumbygningen,Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark
| | - Charles B Kromann
- Centre for Clinical Education, University of Copenhagen and The Capital Region of Denmark, Rigshospitalet Afsnit 5404, Teilumbygningen,Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen and The Capital Region of Denmark, Rigshospitalet Afsnit 5404, Teilumbygningen,Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark
| | - Jesper Eldrup
- Urology Department, Frederiksberg Hospital, University of Copenhagen and The Capital Region of Denmark, Copenhagen Ø, Denmark
| | - Charlotte Ringsted
- Centre for Clinical Education, University of Copenhagen and The Capital Region of Denmark, Rigshospitalet Afsnit 5404, Teilumbygningen,Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark
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Meyerson SL, Tong BC, Balderson SS, D'Amico TA, Phillips JD, DeCamp MM, DaRosa DA. Needs assessment for an errors-based curriculum on thoracoscopic lobectomy. Ann Thorac Surg 2012; 94:368-73. [PMID: 22633499 DOI: 10.1016/j.athoracsur.2012.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/02/2012] [Accepted: 04/05/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research suggests a benefit from a skills curriculum emphasizing error prevention, identification, and management. Our purpose was to identify common errors committed by trainees during simulated thoracoscopic lobectomy for use in developing an error-based curriculum. METHODS Twenty-one residents (postgraduate years 1 to 8) performed a thoracoscopic left upper lobectomy on a previously validated simulator. Videos of the procedure were reviewed in a blinded fashion using a checklist listing 66 possible cognitive and technical errors. RESULTS Of the 21 residents, 15 (71%) self-reported completing the anatomic lobectomy; however, only 7 (33%) had actually divided all of the necessary structures correctly. While dissecting the superior pulmonary vein, 16 residents (76%) made at least one error. The most common (n=13, 62%) was dissecting individual branches rather than the entire vein. On the bronchus, 14 (67%) made at least one error. Again, the most common (n=9, 43%) was dissecting branches. During these tasks, cognitive errors were more common than technical errors. While dissecting arterial branches, 18 residents (86%) made at least one error. Technical and cognitive errors occurred with equal frequency during arterial dissection. The most common arterial error was excess tension on the vessel (n=10, 48%). CONCLUSIONS Curriculum developers should identify skill-specific technical and judgment errors to verify the scope of errors typically committed. For a thoracoscopic lobectomy curriculum, emphasis should be placed on correct identification of anatomic landmarks during dissection of the vein and airway and on proper tissue handling technique during arterial dissection.
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Affiliation(s)
- Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Sangvai S, Mahan JD, Lewis KO, Pudlo N, Suresh S, McKenzie LB. The impact of an interactive Web-based module on residents' knowledge and clinical practice of injury prevention. Clin Pediatr (Phila) 2012; 51:165-74. [PMID: 21985892 DOI: 10.1177/0009922811419027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effectiveness of an interactive Web-based module on knowledge acquisition, retention, and clinical practice by residents. METHODS Residents were randomized to complete an interactive Web-based module on injury prevention or a noninteractive Web-based module of identical content. Acquisition and retention of medical knowledge were measured by pretest, posttest, and long-term test scores, and change in clinical practice was measured by videotaped clinical encounters. RESULTS Fifty-seven residents completed the modules. The control group had higher posttest scores than the intervention group (P = .036). Thirty-seven residents completed the long-term test with scores that were significantly higher than pretest scores (P = .00). Thirty-six residents had videotaped encounter scores (232 visits), with no difference in these scores after the intervention (P = .432). CONCLUSION The noninteractive module was more effective in promoting knowledge acquisition. Residents successfully demonstrated knowledge retention with completion of either module. The modules were insufficient to change clinical practice.
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Affiliation(s)
- Shilpa Sangvai
- Nationwide Children's Hospital, Ambulatory Pediatrics, Columbus, OH 43205, USA.
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Wolbrink TA, Burns JP. Internet-based learning and applications for critical care medicine. J Intensive Care Med 2011; 27:322-32. [PMID: 22173562 DOI: 10.1177/0885066611429539] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Recent changes in duty hour allowances and economic constraints are forcing a paradigm shift in graduate medical education in the United States. Internet-based learning is a rapidly growing component of postgraduate medical education, including the field of critical care medicine. Here, we define the key concepts of Internet-based learning, summarize the current literature, and describe how Internet-based learning may be uniquely suited for the critical care provider. METHODS A MEDLINE/PubMed search from January 2000 to July 2011 using the search terms: "e-learning," "Web-based learning," "computer-aided instruction," "adult learning," "knowledge retention," "intensive care," and "critical care." RESULTS The growth of the Internet is marked by the development of new technologies, including more user-derived tools. Nonmedical fields have embraced Internet-based learning as a valuable teaching tool. A recent meta-analysis described Internet-based learning in the medical field as being more effective than no intervention and likely as efficacious as traditional teaching methods. Web sites containing interactive features are aptly suited for the adult learner, complementing the paradigm shift to more learner-centered education. Interactive cases, simulators, and games may allow for improvement in clinical care. The total time spent utilizing Internet-based resources, as well as the frequency of returning to those sites, may influence educational gains. CONCLUSION Internet-based learning may provide an opportunity for assistance in the transformation of medical education. Many features of Web-based learning, including interactivity, make it advantageous for the adult medical learner, especially in the field of critical care medicine, and further work is necessary to develop a robust learning platform incorporating a variety of learning modalities for critical care providers.
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Affiliation(s)
- Traci A Wolbrink
- Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Management, Children's Hospital Boston, Boston, MA 02115, USA.
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Comer A, Harris AD, Shardell M, Braun B, Belton BM, Wolfsthal SD, Dembry LM, Jacob JT, Price C, Sulis C, Chu ES, Xiao Y. Web-based training improves knowledge about central line bloodstream infections. Infect Control Hosp Epidemiol 2011; 32:1219-22. [PMID: 22080663 DOI: 10.1086/662585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A Web-based training course with embedded video clips for reducing central line-associated bloodstream infections (CLABSIs) was evaluated and shown to improve clinician knowledge and retention of knowledge over time. To our knowledge, this is the first study to evaluate Web-based CLABSI training as a stand-alone intervention.
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Affiliation(s)
- Angela Comer
- Department of Epidemiology and Public Health, Division of Genomic Epidemiology and Clinical Outcomes, University of Maryland, Baltimore, Maryland, USA
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Cherry RA, West CE, Hamilton MC, Rafferty CM, Hollenbeak CS, Caputo GM. Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy. Patient Saf Surg 2011; 5:15. [PMID: 21639916 PMCID: PMC3123176 DOI: 10.1186/1754-9493-5-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 06/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assesses the impact that a resident oversight and credentialing policy for central venous catheter (CVC) placement had on institution-wide central line associated bloodstream infections (CLABSI). We therefore investigated the rate of CLABSI per 1,000 line days during the 12 months before and after implementation of the policy. METHODS This is a retrospective analysis of prospectively collected data at an academic medical center with four adult ICUs and a pediatric ICU. All patients undergoing non-tunneled CVC placement were included in the study. Data was collected on CLABSI, line days, and serious adverse events in the year prior to and following policy implementation on 9/01/08. RESULTS A total of 813 supervised central lines were self-reported by residents in four departments. Statistical analysis was performed using paired Wilcoxon signed rank tests. There were reductions in median CLABSI rate (3.52 vs. 2.26; p = 0.015), number of CLBSI per month (16.0 to 10.0; p = 0.012), and line days (4495 vs. 4193; p = 0.019). No serious adverse events reported to the Pennsylvania Patient Safety Authority. CONCLUSIONS Implementation of a new CVC resident oversight and credentialing policy has been significantly associated with an institution-wide reduction in the rate of CLABSI per 1,000 central line days and total central line days. No serious adverse events were reported. Similar resident oversight policies may benefit other teaching institutions, and support concurrent organizational efforts to reduce hospital acquired infections.
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Affiliation(s)
- Robert A Cherry
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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P Wagner D, J Parker C, E Mavis B, Smith MK. An interdisciplinary infection control education intervention: necessary but not sufficient. J Grad Med Educ 2011; 3:203-10. [PMID: 22655143 PMCID: PMC3184921 DOI: 10.4300/jgme-d-10-00120.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/26/2010] [Accepted: 12/21/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patient care environments are struggling to eradicate health care associated infections and studies of undergraduate and graduate medical trainees have revealed significant gaps in their performance of proper hand hygiene and aseptic technique (HH/AT), suggesting the need for improved curriculum. High-reliability industries have provided a model using standardization of approach and interprofessional training, and both are particularly suited to the teaching and assessment of these life-saving skills. The Infection Control Education project is a grant-funded, multi-institutional pilot launched to improve the teaching and assessment of HH/AT in our community. METHODS An interprofessional team of leaders and educators from 2 local hospital systems and 3 health colleges developed a 9-component "ICE PACK," which includes a unanimously endorsed, detailed HH/AT checklist. This teaching and assessment module was delivered to nursing/medical student and postgraduate year 1 resident/nurse intern pairs. Retention of checklist skills was retested 2 to 5 months after participation in the module. RESULTS Learner pairs participating in the 2-hour module mastered the HH/AT checklist and rated the experience highly. Retention after several weeks was disappointingly low in 2 of the 3 participant groups. CONCLUSIONS A community-wide HH/AT checklist was developed and an ICE PACK of materials created that is portable, standardizes the teaching and assessment of HH/AT skills, and is designed for interprofessional pairs of learners. Retention of checklist steps was disappointing in most of participant groups. Multiple, simultaneous strategies for improving compliance with infection control mandates appear necessary.
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Germ Simulation: A Novel Approach for Raising Medical Students Awareness Toward Asepsis. Simul Healthc 2011; 6:65-70. [DOI: 10.1097/sih.0b013e318206953a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article summarizes the current state of technology as it pertains to quality in the operating room, ties the current state back to its evolutionary pathway to understand how the current capabilities and their limitations came to pass, and elucidates how the overlay of information technology (IT) as a wrapper around current monitoring and device technology provides a significant advance in the ability of anesthesiologists to use technology to improve quality along many axes. The authors posit that IT will enable all the information about patients, perioperative systems, system capacity, and readiness to follow a development trajectory of increasing usefulness.
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Affiliation(s)
- Brian Rothman
- Perioperative Informatics, Vanderbilt University School of Medicine, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232, USA.
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LeMaster CH, Agrawal AT, Hou P, Schuur JD. Systematic review of emergency department central venous and arterial catheter infection. Int J Emerg Med 2010; 3:409-23. [PMID: 21373313 PMCID: PMC3047889 DOI: 10.1007/s12245-010-0225-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 07/27/2010] [Indexed: 01/19/2023] Open
Abstract
Background There is an extensive critical care literature for central venous catheter and arterial line infection, duration of catheterization, and compliance with infection control procedures. The emergency medicine literature, however, contains very little data on central venous catheters and arterial lines. As emergency medicine practice continues to incorporate greater numbers of critical care procedures such as central venous catheter placement, infection control is becoming a greater issue. Aims We performed a systematic review of studies reporting baseline data of ED-placed central venous catheters and arterial lines using multiple search methods. Methods Two reviewers independently assessed included studies using explicit criteria, including the use of ED-placed invasive lines, the presence of central line-associated bloodstream infection, and excluded case reports and review articles. Finding significant heterogeneity among studies, we performed a qualitative assessment. Results Our search produced 504 abstracts, of which 15 studies were evaluated, and 4 studies were excluded because of quality issues leaving 11 cohort studies. Four studies calculated infection rates, ranging 0–24.1/1,000 catheter-days for central line-associated and 0–32.8/1,000 catheter-days for central line-related bloodstream infection. Average duration of catheterization was 4.9 days (range 1.6–14.1 days), and compliance with infection control procedures was 33–96.5%. The data were too poor to compare emergency department to in-hospital catheter infection rates. Conclusions The existing data for emergency department-placed invasive lines are poor, but suggest they are a source of infection, remain in place for a significant period of time, and that adherence to maximum barrier precautions is poor. Obtaining accurate rates of infection and comparison between emergency department and inpatient lines requires prospective study.
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Affiliation(s)
- Christopher H. LeMaster
- Department of Emergency Medicine, Brigham and Women’s Hospital, Neville House, 75 Francis St., Boston, MA 02115 USA
| | - Ashish T. Agrawal
- Department of Emergency Medicine, Brigham and Women’s Hospital, Neville House, 75 Francis St., Boston, MA 02115 USA
| | - Peter Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Neville House, 75 Francis St., Boston, MA 02115 USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Jeremiah D. Schuur
- Department of Emergency Medicine, Brigham and Women’s Hospital, Neville House, 75 Francis St., Boston, MA 02115 USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
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Trotter M, Nomura JT, Sierzenski PR. Single-operator sterile sheathing of ultrasound probes for ultrasound-guided procedures. Acad Emerg Med 2010; 17:e153. [PMID: 21175511 DOI: 10.1111/j.1553-2712.2010.00921.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Trotter
- Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
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Khouli H, Jahnes K, Shapiro J, Rose K, Mathew J, Gohil A, Han Q, Sotelo A, Jones J, Aqeel A, Eden E, Fried E. Performance of medical residents in sterile techniques during central vein catheterization: randomized trial of efficacy of simulation-based training. Chest 2010; 139:80-7. [PMID: 20705795 DOI: 10.1378/chest.10-0979] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal ICU infection. The optimal method to teach health-care providers correct sterile techniques during central vein catheterization (CVC) remains unclear. METHODS We randomly assigned second- and third-year internal medicine residents trained by a traditional apprenticeship model to simulation-based plus video training or video training alone from December 2007 to January 2008, with a follow-up period to examine CRBSI ending in July 2009. During the follow-up period, a simulation-based training program in sterile techniques during CVC was implemented in the medical ICU (MICU). A surgical ICU (SICU) where no residents received study interventions was used for comparison. The primary outcome measures were median residents' scores in sterile techniques and rates of CRBSI per 1,000 catheter-days. RESULTS Of the 47 enrolled residents, 24 were randomly assigned to the simulation-based plus video training group and 23 to the video training group. Median baseline scores in both groups were equally poor: 12.5 to 13 (52%-54%) out of maximum score of 24 (P = .95; median difference, 0; 95% CI, 0.2-2.0). After training, median score was significantly higher for the simulation-based plus video training group: 22 (92%) vs 18 (75%) for the video training group (P < .001; median difference, 4; 95% CI, 3-6). During the follow-up period, there was a significantly lower rate of CRBSI in the MICU (1.0 per 1,000 catheter-days) compared with the SICU (3.4 per 1,000 catheter-days) (P = .03). The incidence rate ratio derived from the Poisson regression (0.30; 95% CI, 0.10-0.91) indicated there was a 70% reduction in the incidence of CRBSI in the postintervention MICU compared with the preintervention MICU and the postintervention SICU. CONCLUSIONS Simulation-based training in sterile techniques during CVC is superior to traditional training or video training alone and is associated with decreased rate of CRBSI. Simulation-based training in CVC should be routinely used to reduce iatrogenic risk. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00612131; URL: clinicaltrials.gov.
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Affiliation(s)
- Hassan Khouli
- Department of Medicine, St Luke’s-Roosevelt Hospital Center, New York, NY 10019, USA.
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Cook DA, Garside S, Levinson AJ, Dupras DM, Montori VM. What do we mean by web-based learning? A systematic review of the variability of interventions. MEDICAL EDUCATION 2010; 44:765-74. [PMID: 20633216 DOI: 10.1111/j.1365-2923.2010.03723.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Educators often speak of web-based learning (WBL) as a single entity or a cluster of similar activities with homogeneous effects. Yet a recent systematic review demonstrated large heterogeneity among results from individual studies. Our purpose is to describe the variation in configurations, instructional methods and presentation formats in WBL. METHODS We systematically searched MEDLINE, EMBASE, ERIC, CINAHL and other databases (last search November 2008) for studies comparing a WBL intervention with no intervention or another educational activity. From eligible studies we abstracted information on course participants, topic, configuration and instructional methods. We summarised this information and then purposively selected and described several WBL interventions that illustrate specific technologies and design features. RESULTS We identified 266 eligible studies. Nearly all courses (89%) used written text and most (55%) used multimedia. A total of 32% used online communication via e-mail, threaded discussion, chat or videoconferencing, and 9% implemented synchronous components. Overall, 24% blended web-based and non-computer-based instruction. Most web-based courses (77%) employed specific instructional methods, other than text alone, to enhance the learning process. The most common instructional methods (each used in nearly 50% of courses) were patient cases, self-assessment questions and feedback. We describe several studies to illustrate the range of instructional designs. CONCLUSIONS Educators and researchers cannot treat WBL as a single entity. Many different configurations and instructional methods are available for WBL instructors. Researchers should study when to use specific WBL designs and how to use them effectively.
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Affiliation(s)
- David A Cook
- Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Audio and Video Recording System for Routine Documentation of Fluoroscopic Procedures. J Vasc Interv Radiol 2010; 21:725-9. [DOI: 10.1016/j.jvir.2010.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 11/08/2009] [Accepted: 01/04/2010] [Indexed: 11/23/2022] Open
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Cherry MG, Brown JM, Neal T, Ben Shaw N. What features of educational interventions lead to competence in aseptic insertion and maintenance of CV catheters in acute care? BEME Guide No. 15. MEDICAL TEACHER 2010; 32:198-218. [PMID: 20218835 DOI: 10.3109/01421591003596600] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Up to 6000 patients per year in England acquire a central venous catheter (CVC)-related bloodstream infection (Shapey et al. 2008 ). Implementation of Department of Health guidelines through educational interventions has resulted in significant and sustained reductions in CVC-related blood stream infections (Pronovost et al. 2002), and cost (Hu et al. 2004 ). AIM This review aimed to determine the features of structured educational interventions that impact on competence in aseptic insertion technique and maintenance of CV catheters by healthcare workers. METHODS We looked at changes in infection control behaviour of healthcare workers, and considered changes in service delivery and the clinical welfare of patients involved, provided they were related directly to the delivery method of the educational intervention. RESULTS A total of 9968 articles were reviewed, of which 47 articles met the inclusion criteria. CONCLUSIONS Findings suggest implications for practice: First, educational interventions appear to have the most prolonged and profound effect when used in conjunction with audit, feedback, and availability of new clinical supplies consistent with the content of the education provided. Second, educational interventions will have a greater impact if baseline compliance to best practice is low. Third, repeated sessions, fed into daily practice, using practical participation appear to have a small, additional effect on practice change when compared to education alone. Active involvement from healthcare staff, in conjunction with the provision of formal responsibilities and motivation for change, may change healthcare worker practice.
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Rosen BT, Uddin PQ, Harrington AR, Ault BW, Ault MJ. Does personalized vascular access training on a nonhuman tissue model allow for learning and retention of central line placement skills? Phase II of the procedural patient safety initiative (PPSI-II). J Hosp Med 2009; 4:423-9. [PMID: 19753570 DOI: 10.1002/jhm.571] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Bradley T Rosen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Capture and Analysis of Data from Image-guided Procedures. J Vasc Interv Radiol 2009; 20:769-81. [DOI: 10.1016/j.jvir.2009.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 02/05/2009] [Accepted: 03/02/2009] [Indexed: 11/19/2022] Open
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Mackenzie CF, Xiao Y, Hu FM, Seagull FJ, Fitzgerald M. Video as a Tool for Improving Tracheal Intubation Tasks for Emergency Medical and Trauma Care. Ann Emerg Med 2007; 50:436-42, 442.e1. [PMID: 17881317 DOI: 10.1016/j.annemergmed.2007.06.487] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 05/03/2007] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE We illustrate how audio-video data records can improve emergency medical care, using airway management to show how such video data may help to identify unsafe acts, accident precursors, and latent and systems failures and to evaluate performance. METHODS This was a retrospective analysis of videos of real patient resuscitation in a trauma center. Participant care providers reviewing their own videos of tracheal intubation identified failures to use diagnostic equipment, fixation errors, and team and communication errors. RESULTS Neutral expert observers noted team coordination failures and poor error recovery. Comparison with a consensus guideline for a tracheal intubation task/communication pathway showed that communications were unclear or not made, and key tasks were omitted by team members. Differences were detected between performance of tracheal intubation in elective and emergency circumstances. Revised practices ("3 Cs": clinical examination, communication, carbon dioxide) mitigated task performance and communication deficiencies. CONCLUSION Video is complementary to traditional quality improvement methods for improving performance in airway management and emergency medical and trauma care, assessing standard operating procedures, and reviewing communications. Video data identify performance details not found in quality improvement approaches, including medical record review or recall by participant care providers. Weaknesses in using video for data include lengthy video review processes, poor audio, and the inability to adequately analyze events outside the field of view. Opportunities are to use video audit for quality improvement of other emergency tasks. Video buffering reduces personnel requirements for capture and simplifies data extraction. Medicolegal and confidentiality threats are significant.
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Affiliation(s)
- Colin F Mackenzie
- Department of Anesthesiology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Ricard JD. Catheters, infection, and videotapes. Crit Care Med 2007; 35:1425-6. [PMID: 17446740 DOI: 10.1097/01.ccm.0000262399.72151.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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