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PubMed2006

[Anonymous critical incident reporting system in anaesthesiology. Results after 18 months].

Two years ago we implemented a reporting system for critical incidents in the Department of Anaesthesiology and Intensive Care of the University Hospital Dresden. During the first 18 months 162 anonymous reports were registered. The most common errors involved airway and ventilation management, followed by errors in fluid and cardio-vascular management. The main causes were distraction, lack of experience, specific training and communication deficits. The confidence in the anonymity of the reporting system was very high. Following the analysis of the reports, several modifications were initiated, e.g. specific training programs or definition of standards. Over time, a change in the relative distribution of reported errors was observed. The article discusses the different kinds of errors and possible countermeasures. It also strengthens several aspects which are important to consider during the initial phase of a local critical incident reporting system.

Anesthesia↗
PubMed2006

Challenges in transitional care between nursing homes and emergency departments.

OBJECTIVE: To obtain opinions of knowledgeable professionals involved in the emergency care of nursing home (NH) residents. DESIGN: Structured focus group interviews. PARTICIPANTS: Five provider categories, including NH staff, NH physicians and nurse practitioners, emergency medical services (EMS) providers, emergency department (ED) nurses, and ED physicians. SETTING: Two NHs, 2 EDs, and a county-wide EMS system. ANALYSIS: Audiotaped discussions were transcribed and analyzed independently by 2 authors. RESULTS: Themes included barriers to providing high-quality care, data needed when residents are transported in both directions between EDs and NHs, and possible solutions to improve care. Communication problems were the most frequently cited barrier to providing care. Residents are often transported in both directions without any written documentation; however, even when communication does occur, it is often not in a mode that is useable by the receiving provider. ED personnel need a small amount of organized, written information. When residents are released from the ED, NH personnel need a verbal report from ED nurses as well as written documentation. All groups were optimistic that communication can be improved. Ideas included use of (1) fax machines or audiotape cassette recorders to exchange information, (2) an emergency form in residents' charts that contains predocumented information with an area to write in the reason for transfer, and (3) brief NH-to-ED and ED-to-NH transfer forms that are accepted and used by local NHs and EDs. CONCLUSION: The transitional care of NH residents is laden with problems but has solutions that deserve additional development and investigation.

Emergency Service, Hospital↗
PubMed2005

Information sharing and children's services reform in England: can legislation change practice?

The Laming Report into the death of Victoria Climbie reiterated the long-standing critique of inadequate communication and coordination amongst the key professions and agencies. It led directly to the Green Paper, Every Child Matters in 2003 and the subsequent Children Act 2004. Amongst other things the Act proposes the establishment of a database on every child, which would be accessible to a range of practitioners - a measure that has been hotly contested. This article examines the reasons for this contestation and explores the extent to which a compromise might be judged to have dislodged a key policy objective.

Child↗
PubMed2003

GPs' views of quality initiatives to improve stroke outcomes following carotid endarterectomy.

BACKGROUND: General practitioners' satisfaction with previous referral of patients may influence their future specialist referral patterns. METHOD: A postal survey of 123 GPs assessing satisfaction with discharge planning and communication from operating surgeons for patients following carotid endarterectomy. General practitioners' views of quality indicators for patient referral also were assessed. RESULTS: General practitioners were significantly more likely to be 'very satisfied' with the level of communication from the operating surgeon (83%) than the discharge planning (65%), (p < 0.001). The most highly ranked quality indicator for use in referring a patient for carotid endarterectomy was the 30 day postoperative complication rate per surgeon (n = 69, 56% 'very useful'). Over one-third (35%) remembered seeing the relevant guidelines for GPs. DISCUSSION: General practitioners value information about surgeon performance when making referral decisions. They are less satisfied with discharge planning than other aspects of care.

Attitude of Health Personnel↗
PubMed2005

[Regional geriatric team--a model for cooperation between nursing homes and hospitals].

Few studies describe and evaluate the use of ambulatory geriatric teams in nursing homes. This article gives an account of a model in which a multidisciplinary group from the local hospital has been visiting 17 communities in Norway twice a year for 11 years. The ambulatory geriatric team includes a geriatrician, a geriatric nurse, a physiotherapist and an occupational therapist. Their aim is to raise the quality of geriatric assessment and care and to enhance the cooperation between the hospital and the nursing homes in the communities. The team members are doing a comprehensive geriatric assessment of some of the patients; they assess cases for further referral, and examine patients with declining functioning with a view to rehabilitation. The team provides instruction in various aspects of geriatrics to community care professionals. Much time is devoted to discussions on problems raised by the staff, such as management of patients with dementia-related behavioural problems, and to provide feedback to staff-members. The team liaise between hospitals, nursing homes and community care services in the communities in order to enhance communication between the professionals involved. An evaluation of the team was done on behalf of the National Institute of Health through a postal questionnaire which was returned by 223 doctors, nurses and allied health care professionals. The results indicate that visits by the ambulatory team improve the knowledge of doctors and allied professionals about diseases in the elderly; 92% reported that they now felt they were doing a better job.

Aged↗
PubMed2005

An analysis of job satisfaction among physician assistants in Taiwan.

The physician assistant (PA) is a relatively new medical specialty that developed to manage the shortage of resident physicians and to ensure that patients receive high-quality health care in today's increasingly complex and demanding medical environment. PAs in Taiwan are not governed by laws and regulations, and the absence of legislation to define their roles and responsibilities can lead to confusion in the work environment and potential communication barriers with coworkers and supervising physicians. The purpose of this exploratory study was to examine the environmental and sociodemographic factors that influence job satisfaction and job-related communication among PAs in Taiwan. The data source, a self-administered mail survey, was sent to 196 PAs working within medical facilities in northern, central, and southern Taiwan. The response rate to the survey was 71.01%. There was a strong correlation between communication satisfaction and job satisfaction among respondents. The PAs' overall position in the hospital, relationships with coworkers (doctors, nurses, and other medical staff), and ability to perform his or her duties while working with the supervising physician were the major environmental factors that influenced job and communication satisfaction. In addition, the number of working years and marital status were important demographic factors influencing job satisfaction. Demographic and environmental factors influencing job satisfaction are analyzed, and ways in which the roles and responsibilities of PAs can be clarified, strengthened, and improved are discussed in an overall effort to provide management strategies for the current PA system in Taiwan.

Adult↗
PubMed2005

Effectiveness of different methods of health education: a comparative assessment in a scientific conference.

BACKGROUND: Every individual mode of health education has its own merits, drawbacks as well as their own sphere of effectiveness. A specific mode of communication is more useful in a specific setting on a specific group than others. To search for optimum mode of communication for a specific audience is a major area of research in health education. The issue of imparting health education to a gathering of educated people, representing different fields of knowledge has remained a relatively less lighted aspect of health education research. In this backdrop this study was initiated for making a comparative assessment of different methods of dissemination of health education among educated people. METHODS: A cross-sectional interviewer administered questionnaire survey was conducted involving 142 randomly selected subjects during the last session of a five-day conference having health as main theme when the opinion of the delegates regarding different communication methods was asked for. Collected data was analyzed not only to find out the optimum mode of education dissemination in such a setting but also to find the contribution of different factors in the preferences of the study subjects. RESULTS: The participants opted more (60%) for focused programs of smaller audience (sectional program). In both broad area (main program) and focused area programs (sectional), the participants preferred lectures (62% and 65.7% respectively). Specific topics were preferred both in lectures (67.6%) and symposia (57.7%). In the exhibition, exhibits seemed to be more attractive (62%) than the posters. Qualification has emerged to be a contributing factor in peoples' choice towards sectional programme and also in their affinity to symposia. Increased age was a significant contributor in participants' preference towards specific topics. Physical barriers of communication appeared to be a problem in the main program as well as in the exhibition. Lack of coherence among the speakers was reported (69%) to be a major reason for which symposia was not preferred. CONCLUSION: This study concluded that while planning for health education dissemination in an educated group a focused programme should be formulated in small groups preferably in the form of lectures on specific topics, more so while dealing with participants of higher age group having higher educational qualification.

Adult↗
PubMed2006

Pharmacovigilance during the pre-approval phases: an evolving pharmaceutical industry model in response to ICH E2E, CIOMS VI, FDA and EMEA/CHMP risk-management guidelines.

Pharmacovigilance science has traditionally been a discipline focussed on the postmarketing or post-authorisation period, with due attention directed towards pre-clinical safety data, clinical trials and adverse events. As the biological sciences have evolved, pharmacovigilance has slowly shifted toward earlier, proactive consideration of risks and potential benefits of drugs in the pre- and peri-approval stages of drug development, leading to a maturing of drug safety risk management. Further advances in biology, pharmacology and improvements in computational applications to medicine have led to the development of more complex medicines previously unobtainable and have also permitted a more thorough assessment of risks and potential benefits even earlier in the development process. Elevated public concern with the safety of more sophisticated medicines, combined with new science, have led pharmaceutical innovators, regulators and healthcare professionals to collaborate to develop guidelines, which drive enhanced pharmacovigilance and safety risk management earlier in drug development. In this paper, we review international guidelines on pharmacovigilance planning applicable to the pre-approval phases of medicines development and provide author opinion on these guidelines' potential drug safety implications. We discuss the possible evolution of a pharmaceutical industry model to respond to these guidelines; a view on multidisciplinary safety management teams is provided to encourage refinement of safety-signal identification and risk assessment early in drug development and to communicate important safety concerns to internal research efforts, patients, investigators and regulators. We further describe these functions in the context of the complexities of vulnerable populations, including the example of medicines research for paediatric populations. We also discuss the special role of epidemiology in pre-approval drug development and the impact on epidemiological science of changes to the pharmacovigilance paradigm.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Implementation of antibiotic management teams in Belgian hospitals.

In 2002-03, the Belgian government subsidized in part the activities of local Antibiotic Managers (AMs) in 36 hospitals selected based on the presence of an operational multidisciplinary Antibiotic Management Team (AMT). AMs were trained as Internists (28), Microbiologists (13) and Hospital Pharmacists (13). The hospitals were representative of Belgian hospitals in affiliation, regional origin and size. The financing scheme allowed the implementation of 175 antibiotic management interventions, with a mean of 5 interventions/hospital. The activities reported in the first 9-month progress reports were analyzed according to national guidelines for AMTs. All hospitals irrespective of size or affiliation had undertaken a wide range of measures: review of formulary (29), implementation of new clinical guidelines (24), restricted access to selected antibiotics (25), improvement of antibiotic susceptibility testing methods (12), development of antibiotic consumption database (35) and analysis of antibacterial susceptibility data (31). Advertisement type categorization of communication methods showed that education of prescribers was based on multimodal communication. All hospitals used at least one passive method, 39% at least one active method and 55% at least one personalized method. The quality of communication was higher in hospitals with teaching affiliation. In conclusion, hospitals that received a financial incentive under theAMT pilot phase have developed multimodal antibiotic policy interventions independently of the hospital size and teaching status. Extension to all Belgian hospitals appears warranted. The impact of AMTs and AMs on the quality of use of antibiotics and trends of antibiotic resistance and cost will be monitored based on standardized indicators.

Anti-Bacterial Agents↗
PubMed2006

Managing the patient journey through enteral nutritional care.

Nutritional support provision does not happen by accident. Clinical dimensions include screening and assessment, estimation of requirements, identification of a feeding route and the subsequent need for monitoring. Patients may need different forms of nutritional intervention during the course of their illness. Furthermore, these may need to be provided in different locations as their clinical status changes. If this is not properly managed there is potential for inappropriate treatment to be given. Clinical processes can only be effectively implemented if there is a robust infrastructure. The clinical team need to understand the different elements involved in effective service provision and this depends on bringing together disciplines which do not feature overtly on the clinical agenda including catering, finance and senior management. Excellent communication skills at all levels, financial awareness and insight into how other departments function are fundamental to success. Practice needs to be reviewed constantly and creativity about all aspects of service delivery is essential. Finally, it is important that key stakeholders are identified and involved so that they can support any successes and developments. This will raise awareness of the benefits of nutritional intervention and help to ensure that the right resources are available when they are needed.

Community Health Services↗
PubMed1991

Ethics consultation: skills, roles, and training.

A clinical ethics consultant gathers information firsthand at the patient's bedside. The consultant's special clinical skills include the ability to identify and analyze ethical problems; use reasonable clinical judgment; communicate effectively; negotiate and facilitate negotiations; and teach others how to construct their own ethical frameworks for medical decision making. Appropriate roles for the consultant include those of professional colleague, negotiator, patient and physician advocate, case manager, and educator. The training necessary for an ethics consultant includes substantial patient care experience, instruction in health care law and moral reasoning, and preparation in medical humanism. We favor a clinical model for ethics consultation. When urgent care is needed, other consultants promptly see the patient; the clinical ethics consultant can be expected to do the same.

Certification↗
PubMed2004

Facilitators and barriers for co-ordinated multi-agency services.

BACKGROUND: Greater collaboration between agencies and the need to improve interagency working is a key policy priority. The lack of co-ordinated multi-agency working in children's services has been highlighted in many research studies. Evidence on the facilitators of and barriers to such working and the outcomes for children and families of co-ordinated services is important to inform local developments. METHODS: Literature on multi-agency working was reviewed as part of the evidence gathering to inform the Children's National Service Framework. Searches were mainly concentrated on existing reviews, plus recent studies which included children's services and were not covered by the reviews obtained. RESULTS: There is little evidence on the effectiveness of multi-agency working itself or of different models of such working in producing improved outcomes for children and families. However, reviews of evidence on multi-agency working provide consistent findings on facilitators and barriers, including: clear aims, roles and responsibilities and timetables that are agreed between partners; a multi-agency steering group, commitment at all levels of the organizations involved and good systems of communication and information sharing, including IT systems, are central; support and training for staff in new ways of working is needed. There is some evidence that interprofessional programmes of continuing education can help to remove barriers to joint working. CONCLUSIONS: Existing research provides useful information for organizations developing multi-agency services. However, there is a need for methodologically sound research which investigates the outcomes of different models of multi-agency working in services for children, includes assessment of cost effectiveness, and explores the ways in which the factors identified as facilitating multi-agency working relate to outcomes.

Child↗
PubMed2005

NACCHO GP Network--enhancing communication in Aboriginal health.

BACKGROUND: Communication between general practitioners, information sharing, and GP support are important issues, especially for those in rural and remote areas. Internet based links can facilitate enhanced communication. OBJECTIVE: This article describes the new internet based communication forum for GPs working, or interested in the health of, Aboriginal and Torres Strait Islander peoples. DISCUSSION: The NACCHO GP Network is the first on-line service to provide focussed information for GPs in the Aboriginal community controlled health sector. It also provides a place for GPs, locums and general practice registrars to raise issues and share ideas and information on Aboriginal health practice. The NACCHO GP Network has the potential to reduce isolation and address the support needs of GPs, and enhance the interaction of the Aboriginal community controlled sector with general practice organisations.

Australia↗
PubMed2002

Cross-cultural encounters between careproviders: rabbis' referral letters to a psychiatric clinic in Israel.

This paper explores the meaning and social functions of referral letters sent to a mental health clinic in Israel by Haredi (ultra-orthodox) rabbis. The letters exemplify social mechanisms by which various institutions and individuals (careproviders, therapists, and other social actors) negotiate different therapies, advice, and interventions in cross-cultural encounters. We argue that beyond the practical functions of the letters, the rabbis-representatives of a "popular" and religious social sphere-use them to negotiate their position in relation to the psychiatric clinic as a representative of a professional and secular sphere. We show that the rabbis "submit" to the professional and secular therapists by using a local adaptation of Western psychological and psychiatric discourses (instead of a religious or mystical discourse), but also that by choosing a letter as their preferred medium of communication (instead of a personal visit to the clinic), they distance themselves from it. We suggest that the rabbis reconstitute, via the letters, social boundaries within their religious community and between their community and secular society. Hence, through analysis of discourses of mental illness in a cross-cultural encounter we examine ways in which illness is practically managed among diverse groups in society. Specifically, we analyze such discourses as part of a power relationship between careproviders who belong to different therapeutic social spheres, using a phenomenological exploration of how mental illness is perceived and constructed as both "a medical problem" and as "social deviance".

Clergy↗
PubMed2003

[Information transfer between health structures. How and to whom is the information transferred?].

The evolution of the French health-care system is based on the development of patient management in the health-care system. The public services associate nurses with alternatives to hospitalization in order to favor the emergence of such facilities. This evolution changes the habits and the needs of professionals. Communication between the nurses is the basis of this function. In order to assure the continuity of health-care, both private and hospital nurses need information. However this is either not the case, or is inadequate to the expectations and needs of the nurses. The motives will be analyzed and some proposals offered. In recording and analyzing liaison records, interesting accounts were revealed which foresees the possibilities of an evolution at the information network level between the hospital and the extra-hospital sector. Some propositions will be put forth in order to assure a greater coherence in the endeavor for health-care continuity.

Attitude of Health Personnel↗
PubMed1992

Exploring the role of the ethics committee psychiatrist.

Healthcare ethics committees (HEC) have emerged as institutional forums for addressing bioethical dilemmas. Psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication within the committee and as HEC-based clinical ethics consultants. HECs must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to HECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about ethical aspects of health care suggests they would make excellent committee leaders. Psychiatrists also have important committee roles to play as ethics educators and policy makers. More demographic data is needed to investigate psychiatrist participation on HECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for HEC psychiatrists.

Decision Making, Organizational↗
PubMed2005

A web-based system for managing and co-ordinating multiple multisite studies.

Efficient and secure collection and management of information is essential in any modern biomedical study. Data management and coordination of multisite studies is a complex process. It involves development of systems for data collection, data cleaning with quality assurance checks, and specimen tracking, as well as development of procedures for conducting the study, training clinical sites, and communicating with sites to answer study questions and resolve and track data inquiries and resolutions. We developed a secure web-based system that is designed to automate evaluation of eligibility criteria and data collection, track specimens, serve as a resource for study-specific information, facilitate communication across sites in multisite studies, track data queries and resolutions, and allow administrative management of studies. The system combines a common framework across studies that defines the internal structure for all the web pages, with a study-specific one that defines the content of each page via a relational database. This combination creates a flexible and efficient environment enabling several multisite studies to be simultaneously or consecutively implemented and managed in a timely manner. We describe the development process, the system and its evaluation, current status, lessons learned, and future development plans.

Biomarkers, Tumor↗
PubMed2005

Post-traumatic eye observations.

Retrobulbar haemorrhage after facial trauma or surgery is an uncommon but well-documented complication. The assessment and management of this condition is variable. We asked 288 maxillofacial surgeons in the UK about the signs and symptoms, incidence, and management of retrobulbar haemorrhage. We also enquired about the regimen that they used for eye observations, the patients who, in their opinion, required observation, and the method of communication of instructions to the nursing staff. A total of 185 responded (64%). Each surgeon had seen a mean of 1.3 cases of retrobulbar haemorrhage, of which most, n=190 (91%) were treated by surgery. There were 96 different eye observations regimens documented. There was a general consensus about the signs and symptoms, and 82 (44%) of respondents used a proforma for recording eye observations. On the basis of this study we recommend a standard regimen for eye observations, and have a designed a facial injury advice sheet to be given to patients who attend the accident and emergency department and are to be discharged home and followed up at a later date.

Clinical Protocols↗