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PubMed1993

Medical ethics in medical education: finding and keeping a place at the table.

Although almost three decades have passed from the early days of the modern medical ethics movement, both articles discussed here manifest variations of some old concerns. First, an acceptance of ethics is incorporated into general requirements and found in specific programs, but ethics is not given great attention by those who decide who will enter the medical profession. Second, in the clinical setting itself, practitioners are busy and the teaching process is placed amidst a multitude of other concerns. And third, the goals for resident and faculty education are remarkably similar to those proposed for undergraduates (awareness, development of analytical skills, involvement in patient care, and so forth). The evaluation of ethics instruction, which has been a concern since the 1960s, has a new face. Upon entering the medical-education setting, humanists found that there was a need for accountability that they had not generally experienced in their university teaching. Yet, they also knew that ethics was different from other medical courses, and that quantifying its special contribution was difficult. Today's general societal emphasis on cost and outcome as measures of the value of education gives consideration of evaluation a critical role. White and Zaner, and most of the other authors cited here, mention the need for systematic accounting of the results of teaching, as well as the difficulty of evaluation. The evaluation of the effectiveness of ethics instruction will remain problematic, yet it is necessary in the changing health-care market. To the degree to which it is possible to communicate knowledge about ethics, residency and other accrediting bodies can provide means to evaluate the results of teaching.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMed2003

Discrepant attitudes about teamwork among critical care nurses and physicians.

OBJECTIVE: To measure and compare critical care physicians' and nurses' attitudes about teamwork. DESIGN: Cross-sectional surveys. SETTING: Eight nonsurgical intensive care units in two teaching and four nonteaching hospitals in the Houston, TX, metropolitan area. SUBJECTS: Physicians and nurses who worked in the intensive care units. MEASUREMENTS AND MAIN RESULTS: Three hundred twenty subjects (90 physicians and 230 nurses) responded to the survey. The response rate was 58% (40% for physicians and 71% for nurses). Only 33% of nurses rated the quality of collaboration and communication with the physicians as high or very high. In contrast, 73% of physicians rated collaboration and communication with nurses as high or very high. By using factor analysis, we developed a seven-item teamwork scale. Multivariate analysis of variance of the items yielded an omnibus ( [7, 163] = 8.37; p <.001), indicating that physicians and nurses perceive their teamwork climate differently. Analysis of individual items revealed that relative to physicians, nurses reported that it is difficult to speak up, disagreements are not appropriately resolved, more input into decision making is needed, and nurse input is not well received. CONCLUSIONS: Critical care physicians and nurses have discrepant attitudes about the teamwork they experience with each other. As evidenced by individual item content, this discrepancy includes suboptimal conflict resolution and interpersonal communication skills. These findings may be the result of the differences in status/authority, responsibilities, gender, training, and nursing and physician cultures.

Adult↗
PubMed2005

A qualitative study of health-care personnel's experience of a satellite pharmacy at a HIV clinic.

OBJECTIVE: The aim of the study was to investigate how health-care personnel at a HIV clinic perceived conventional pharmacies in Sweden and whether the decentralization of pharmaceutical services to the HIV clinic had led to an improved collaboration between other health-care professionals and pharmacists. METHODS: Doctors and nurses who had regular contacts with HIV patients and the satellite pharmacy were interviewed. The interviews were semi-structured, using open questions and was analysed according to the phenomenographic approach. RESULTS: The respondents perceived the existing co-work between conventional pharmacies and other health care professionals as limited. The availability of the satellite pharmacy enabled the health care professionals to understand the pharmacys' way of working, and to increase trust in the pharmacy staff. Collaboration was hence developed between the professions, leading to a consistent way of informing the patients about their HIV drugs, thereby avoiding contradictory information. The pharmacist also became involved in adherence promoting activities at the clinic. The perceived benefits for the patients were considered to be convenience and preservation of privacy as well as a better basis for safe and appropriate drug utilisation. CONCLUSION: Conventional pharmacies were shown to have several disadvantages in serving the HIV infected population. The health care professionals found the novel approach of dispensing HIV drugs at the clinic valuable. The approach led to increased communication and trust between the health care professions, and enhanced teamwork in medication management.

Attitude of Health Personnel↗
PubMed2006

A systematic review of the literature on multidisciplinary rounds to design information technology.

Multidisciplinary rounds (MDR) have become important mechanisms for communication and coordination of care. To guide design of tools supporting MDR, we reviewed the literature published from 1990 to 2005 about MDR on information tools used, information needs, impact of information tools, and evaluation measures. Fifty-one papers met inclusion criteria and were included. In addition to patient-centric information tools (e.g., medical chart) and decision-support tools (e.g., clinical pathway), process-oriented tools (e.g., rounding list) were reported to help with information organization and communication. Information tools were shown to improve situation awareness of multidisciplinary care providers, efficiency of MDR, and length of stay. Communication through MDR may be improved by process-oriented information tools that help information organization, communication, and work management, which could be achieved through automatic extraction from clinical information systems, displays and printouts in condensed forms, at-a-glance representations of the care unit, and storing work-process information temporarily.

Humans↗
PubMed2003

[Communication of useful information from laboratory physicians to clinical physicians].

In recent years increasing importance has been placed on the role of hospital clinical research, such as the promotion of intra-laboratory human, material and informational resources, previously restricted to the laboratory, to the whole hospital system, and the appropriate usage of laboratory findings via common consultation systems, or specialized informational consultants in the clinical laboratory department. The volume of clinical laboratory information, which plays an important role in the decision-making process of routine clinical practices, is enormous for each individual hospital, and appropriate use of this information has a major influence on institutional clinical practice efficiency. In response to the need for the communication of useful laboratory information to clinical physicians, departments of laboratory research consultants have been organized in individual hospitals as a way forward. In the near future, laboratory physicians will play a leading role in the communication of research information from the viewpoint of EBLM (evidence-based laboratory medicine). From the work of these laboratory research consultants, it becomes possible to obtain relevant EBLM-related information, such as frequently asked questions and opinions, from their users. By replying to these questions and opinions appropriately, laboratory research consultants can provide information that is both advantageous and useful, and which meets the needs of the clinical physician side. Effective communication of useful laboratory research information should not be restricted to either the laboratory physicians or the technicians; it is a job that needs the cooperation and teamwork of both sets of people. Also, they should always keep in mind that communication by itself is not sufficient; they should not assume the useful evaluation of information by the users, but rather ensure that they are presented with information that precisely meets their needs.

Clinical Laboratory Information Systems↗
PubMed2006

The complexity of communication in an environment with multiple disciplines and professionals: communimetrics and decision support.

Accurate and efficient communication among all the parties is an important component of providing efficient and effective medical care to patients who have complex needs. The evolution of clinimetric measurement approaches designed to be congruent with the clinical process into communimetric tools designed to communicate the clinical process to wider audiences allows the use of technology to support improved care. Computerized medicine offers many opportunities for speeding up the communication of data and thereby improving the efficiency and effectiveness of medical care. The use of communimetric tools within this information environment represents an important opportunity to bridge the quality chasm.

Decision Support Systems, Clinical↗
PubMed2004

Factors impacting on nurse managers' ability to be innovative in a decentralized management structure.

Several studies indicate that management styles and knowledge of organizational structures have an impact on the potential for staff innovation. This exploratory study was conducted to investigate the implications of such variables in relation to nursing managers in a public sector health organization in Victoria, Australia. It reviewed factors that appeared to impact and encourage innovative behaviour amongst nurse managers within a decentralized management structure. To evaluate nurse managers' ability to be innovative, a 55-item survey consisting of both open questions and Likert-type scale questions was developed and distributed to 140 nurse managers working in a public sector health organization. The response rate was 58% yielding 82 usable responses. The study findings revealed that factors of management structures and management styles, in conjunction with the nurse unit managers' perceptions and communication skills, had an impact on nurse manager's ability to exhibit innovative behaviour in the 21st century workplace.

Attitude of Health Personnel↗
PubMed2005

Communication of bed allocation decisions in a critical care unit and accountability for reasonableness.

BACKGROUND: Communication may affect perceptions of fair process for intensive care unit bed allocation decisions through its impact on the publicity condition of accountability for reasonableness. METHODS: We performed a qualitative case study to describe participant perceptions of the communication of bed allocation decisions in an 18-bed university affiliated, medical-surgical critical care unit at Sunnybrook and Women's College Health Sciences Centre. Interviewed participants were 3 critical care physicians, 4 clinical fellows in critical care, 4 resource nurses, 4 "end-users" (physicians who commonly referred patients to the unit), and 3 members of the administrative staff. Median bed occupancy during the study period (Jan-April 2003) was 18/18; daily admissions and discharges (median) were 3. We evaluated our description using the ethical framework "accountability for reasonableness" (A4R) to identify opportunities for improvement. RESULTS: The critical care physician, resource nurse, critical care fellow and end-users (trauma team leader, surgeons, neurosurgeons, anesthesiologists) functioned independently in unofficial "parallel tracks" of bed allocation decision-making; this conflicted with the official designation of the critical care physician as the sole authority. Communication between key decision-makers was indirect and could exclude those affected by the decisions; notably, family members. Participants perceived a lack of publicity for bed allocation rationales. CONCLUSION: The publicity condition should be improved for critical care bed allocation decisions. Decision-making in the "parallel tracks" we describe might be unavoidable within usual constraints of time, urgency and demand. Formal guidelines for direct communication between key participants in such circumstances would help to improve the fairness of these decisions.

Attitude of Health Personnel↗
PubMed2006

Making better use of technological advances to meet stakeholder needs.

Controlling transboundary diseases requires an inclusive and collaborative international approach. Decisions should be taken (and seen to be taken) on advice from multidisciplinary teams of scientists and representatives from all groups significantly affected by the disease (the 'stakeholders'). Changes in trade and travel mean that, unless a new model is developed for disease prevention, there is a real possibility that transboundary animal diseases will become increasingly difficult to control. The traditional government approach of dealing almost exclusively with the commercial sector of the livestock industry is no longer sufficient, and new ways must be found to include all sectors, including 'grey' husbandry (fragmented, disparate groups whose involvement with animals may range from the legal and responsible to the unsanctioned and/or illegal). The increasing convergence of human and animal health issues makes it imperative to make the best possible use of new tools. The particular challenges confronting veterinary science are: preventing the introduction of disease, rapidly identifying disease and controlling epidemics. This paper focuses on the United Kingdom to investigate the inadequacies of current approaches, identify needs, offer recommendations and propose a new approach to disease control, which emphasises global considerations. The objectives are: better participation across the entire sector, better communication, better science and better decision-making, all of which should lead to better security from disease.

Animal Diseases↗
PubMed2004

The perioperative practitioner.

This article demonstrates how patient care can be compromised when vital patient information is not communicated to the team in the operating theatre. It challenges practitioners to consider the information required to properly care for our patients. Several members of NATN were asked to comment on this article and these are reproduced at the end.

Aged↗
PubMedDate not supplied

Medico-legal issues in radiological consultation.

Providers increasingly use radiological services for diagnosis and treatment. Both the referring physician and the radiological consultant can contribute to efficient and effective consultation, and direct interaction may facilitate the process further. Furthermore, inadequate communication can influence poor patient outcome. We examine the roles and responsibilities of referring physicians and consultant radiologists, and present a malpractice case, Townsend v. Turk 218 Cal. App. 3d 278 (1990), to identify medico-legal issues in radiological consultation. Important issues are implied by the Townsend case. First, it is the clinician's responsibility to include clinical information that is appropriate and adequate. Further, the radiologist is a valuable resource in the selection of the optimal procedure, provided that he or she is aware of the patient's history. The second issue discussed by the court represents a possibly more pervasive problem. The interaction between a consulting radiologist--indeed any specialist--and a treating physician is subject to difficulties caused by different conceptions of professional boundaries. The position taken by the court in the Townsend case is consistent with the traditional view that a consulting radiologist has an attenuated duty to the patient. It also would seem to receive at least some support from the language contained in the current revision of the ACR Standard for Communication: Diagnostic Radiology, effective Jan. 1, 2002: ...The referring physician or healthcare provider also shares in the responsibility of obtaining results of imaging studies they have ordered. Despite the result of the Townsend case and the current formulation of the ACR Standards, however, radiologists face risks of litigation. Indeed, the emerging trend in radiological consultation is the direct communication of results to the patient. It is clear that improved communication between radiologists and referring physicians is both desirable and imperative. Clinico-radiological encounters yield additional clinical information and guide the decision-making process. In the Townsend case, direct interaction would have resolved ambiguity.

Accidents, Aviation↗
PubMed2003

Questionnaire for teachers changes the outcome of school entrance medical examinations.

OBJECTIVE: To evaluate the impact of a teachers' questionnaire on the outcome of school entrance medical examinations (SEMs). METHODOLOGY: Retrospective audit. Routine SEMs in 17 primary schools before and after the introduction of the questionnaire. RESULTS: Primary outcome was teachers' concerns known to school doctors, which increased from 2% of pupils to 27% (P < 0.001). Secondary outcome measures increased significantly: new diagnoses made by school doctors (22-31%, P = 0.038) and follow-ups arranged (8-15%, P = 0.034). Medical or educational intervention was required in 17% of pupils identified by teachers' concerns over the subsequent 3 years. Used as an adjunct for selection for SEMs, the questionnaire would have reduced the number of children with problems overlooked by 60%. CONCLUSIONS: The questionnaire improves communication between teachers and school doctors. It significantly changed the short- and longer-term outcome of SEMs. The teachers' questionnaire provides a useful adjunct for selection for SEMs.

Child↗
PubMed2006

Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward.

Our objective was to discuss obstacles and barriers to effective communication and collaboration regarding end-of-life issues between intensive care unit nurses and physicians. To evaluate practical interventions for improving communication and collaboration, we undertook a systematic literature review. An increase in shared decision making can result from a better understanding and respect for the perspectives and burdens felt by other caregivers. Intensive care unit nurses value their contributions to end-of-life decision making and want to have a more active role. Increased collaboration and communication can result in more appropriate care and increased physician/nurse, patient, and family satisfaction. Recommendations for improvement in communication between intensive care unit physicians and nurses include use of joint grand rounds, patient care seminars, and interprofessional dialogues. Communication interventions such as use of daily rounds forms, communication training, and a collaborative practice model have shown positive results. When communication is clear and constructive and practice is truly collaborative, the end-of-life care provided to intensive care unit patients and families by satisfied and engaged professionals will improve markedly.

Cooperative Behavior↗
PubMed2005

Impact of an annual retreat on process improvement in a respiratory therapy section.

BACKGROUND: In order to fulfill the mission of providing superb respiratory care, managing respiratory care services requires communication and collaboration. To enhance communication and collaboration in our Section of Respiratory Therapy at the Cleveland Clinic Foundation, and to generate ideas for improvement, since 1996 we have conducted annual retreats for the Section, during which important challenges and opportunities are discussed in a large-group forum. The current report describes the retreat process and outcomes, namely the ideas generated during these retreats and the frequency with which ideas were implemented successfully. METHODS: The annual retreat brings together all clinical specialists, supervisors, and managers in the Section of Respiratory Therapy, along with the medical director of Respiratory Therapy and representatives of the staff from each shift. In advance of the annual half-day retreat, supervisors and clinical specialists are asked to write a brief description of things that need improvement and actionable proposed solutions to these challenges. These documents are reviewed by the supervisors, managers, education coordinator, and medical director, and a list of discussion topics for the retreat is formulated. The retreat day begins with a brief introduction and summary of the year's activities and then encourages open-ended discussions regarding the various topics, with the explicit, repeated goal of generating solutions. Minutes are kept to identify specific action items, a list of which is visited repeatedly throughout the year, to assess progress toward successful completion of each action item. In the current analysis, the primary outcome measures are the number of ideas generated as action items during the retreats and the frequency with which these ideas have been implemented. RESULTS: Over the 8 years of annual retreats, 103 action items have been generated, of which 84% (n = 87) have been successfully implemented or completed. As evidence of the importance of this group-based activity, we cite several examples of suggestions and action items that were felt to uniquely represent group process and wisdom and which were not proposed beforehand by individuals. CONCLUSIONS: On the basis of this experience, we recommend conducting annual respiratory therapy department retreats. We believe the benefits include collective problem-solving in a public forum to identify solutions not advanced by individuals. Also, we believe that the direct communication in such retreats contributes to enhanced morale, further evidence of which is the very low turnover rate among our respiratory therapists during the 8 years in which we have conducted annual retreats.

Concept Formation↗
PubMed2004

[What do general practitioners expect from the department of neurology?].

BACKGROUND: In the only department of neurology for the two northernmost counties of Norway, activities are organised to minimize waiting time for examination. In order to improve provision of services, we asked general practitioners (GPs) for advice in a questionnaire survey. MATERIAL AND METHODS: A postal questionnaire was sent to all general practitioners in the two northernmost counties of Norway. They were asked to suggest order of priority that might improve care for patients referred for headache and point out patient groups who need better services. RESULTS: A total of 177 out of 269 GPs returned the questionnaire (66%). The highest rated suggested activities were telephone meetings with a specialist and written information with criteria for the selection of patients who need a specialist consultation for headache. Responders were of the opinion that higher priority should be given to primary degenerative disorders of the brain such as Parkinson's disease and dementia disorders. INTERPRETATION: The study showed that better communication between specialists and GPs may improve services for those with headache. Increased knowledge about groups of patients who need improved care could be achieved by asking GPs working in the community for advice.

Family Practice↗
PubMed2005

JCAHO's safety goals--the clock is ticking, will your ED be compliant?

To comply with new safety goals from the Joint Commission on Accreditation of Healthcare Organizations, use specific processes and policies designed to minimize likelihood of errors. Nurse-to-nurse communication is the preferred method to use when handing off patients. Meet with staff on a regular basis to assess how well you are meeting Joint Commission requirements. Prepackaged medications can help you and your staff meet the new medication labeling goal.

Accreditation↗