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Austin F Mount-Campbell, Michael F Rayo, James J OʼBrien, Theodore T Allen, Emily S Patterson
Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories...
October 2016: Quality Management in Health Care
Katherine Lambe, Judy Currey, Julie Considine
BACKGROUND: Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care. METHODS: A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia...
October 7, 2016: Australasian Emergency Nursing Journal: AENJ
Joanna R Watson, Darerca Owen, Helen R Mott
The small GTPase, Cdc42, is a key regulator of actin dynamics, functioning to connect multiple signals to actin polymerization through effector proteins of the Wiskott-Aldrich syndrome protein (WASP) and Transducer of Cdc42-dependent actin assembly (TOCA) families. WASP family members serve to couple Cdc42 with the actin nucleator, the Arp2/3 complex, via direct interactions. The regulation of these proteins in the context of actin dynamics has been extensively studied. Studies on the TOCA family, however, are more limited and relatively little is known about their roles and regulation...
August 11, 2016: Small GTPases
Eric Mayor, Adrian Bangerter
AIM: To document the prevalence of perturbations of handover meetings and understand how nurses manage temporal, physical and social meeting boundaries in response to perturbations. BACKGROUND: Handovers are joint activities performed collaboratively by participating nurses. Perturbations of handover are frequent and may potentially threaten continuity of care. DESIGN: We observed and videotaped handovers during five successive days in four nursing care units in two Swiss hospitals in 2009...
November 2015: Nurs Open
Emma Saunsbury, Gabrielle Howarth
Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this...
2016: BMJ Quality Improvement Reports
R M Heaney, I Reynolds, R S Ryan, I Khan, W Khan, R Waldron, K Barry
BACKGROUND: Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary. AIMS: In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services...
September 8, 2016: Irish Journal of Medical Science
Sean M Bagshaw, Dawn Opgenorth, Melissa Potestio, Stephanie E Hastings, Shelanne L Hepp, Elaine Gilfoyle, David McKinlay, Paul Boucher, Michael Meier, Jeanna Parsons-Leigh, R T Noel Gibney, David A Zygun, Henry T Stelfox
OBJECTIVES: Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain. DESIGN: Qualitative study using a conventional thematic analysis...
September 15, 2016: Critical Care Medicine
Faraz Shafiq, Muhammad Irfan Ul Haq
No abstract text is available yet for this article.
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
Marian Smeulers, Hester Vermeulen
OBJECTIVE: Standardization of the handover process is deemed necessary to ensure continuity and safety of care. However, local context is considered of equal importance to improve the handover process. Our objective was to determine what recommendations on standardized shift handover nurses make, if we combine evidence from the literature with the local context of the nurses. DESIGN: A RAND-modified Delphi consensus process that combines evidence from systematic reviews with expert opinion of local nurses and an evaluation of the consensus process with a survey...
September 12, 2016: International Journal for Quality in Health Care
Natalie Cram, Shelley McLeod, Michael Lewell, Matthew Davis
OBJECTIVE: To determine how often the Ambulance Call Record (ACR) was available to emergency department (ED) physicians and whether it contained information that changed the ED management of patients. METHODS: This was a prospective cohort study of adult patients transported to one of two tertiary care centre EDs. Physicians completed a data collection form for each patient regarding ACR availability and the perceived value of the ACR. This study began shortly after the implementation of a new electronic ACR (eACR) handover process (Round 1)...
September 13, 2016: CJEM
George J E Crowther, Michael I Bennett, John D Holmes
INTRODUCTION: in the United Kingdom dementia is generally diagnosed by mental health services. General hospitals are managed by separate healthcare trusts and the handover of clinical information between organisations is potentially unreliable. Around 40% of older people admitted to hospital have dementia. This group have a high prevalence of psychological symptoms and delirium. If the dementia diagnosis or symptoms are not recognised, patients may suffer unnecessarily with resulting negative outcomes...
September 10, 2016: Age and Ageing
Maree Johnson, Paula Sanchez, Catherine Zheng, Barbara Chapman
We conducted a feasibility study to test an intervention to reduce medication omissions without documentation using nurse-initiated recall cards and medication chart checking at handover. No significant difference in the omission rate per 100 medications was found, although after adjusting for hospital and patient age, a significant effect occurred in the intervention group (n = 262 patients) compared with the control group (n = 272). This intervention may reduce medication omissions without documentation, requiring further study within larger samples...
September 7, 2016: Journal of Nursing Care Quality
Rosanne van Seben, Suzanne E Geerlings, Kim J M Verhaegh, Carina G J M Hilders, Bianca M Buurman
BACKGROUND: Accurate and timely patient handovers from hospital to other health care settings are essential in order to provide high quality of care and to ensure patient safety. We aim to investigate the effect of a comprehensive discharge bundle, the Transfer Intervention Procedure (TIP), on the time between discharge and the time when the medical, medication and nursing handovers are sent to the next health care provider. Our goal is to reduce this time to 24 h after hospital discharge...
2016: BMC Health Services Research
Mareike Przysucha, Daniel Flemming, Ursula Hübner
Innovations are typically characterised by their relative newness for the user. In order for new eHealth applications to be accepted as innovations more criteria were proposed including "use" and "usability". The handoverEHR is a new approach that allows the user to translate the essentials of a clinical case into a graphical representation, the so-called cognitive map of the patient. This study aimed at testing the software usability. A convenience sample of 23 experienced nurses from different healthcare organisations across the country rated the usability of the handoverEHR after performing typical handover tasks...
2016: Studies in Health Technology and Informatics
John Q Young, Savannah M van Dijk, Patricia S O'Sullivan, Eugene J Custers, David M Irby, Olle Ten Cate
CONTEXT: The handover represents a high-risk event in which errors are common and lead to patient harm. A better understanding of the cognitive mechanisms of handover errors is essential to improving handover education and practice. OBJECTIVES: This paper reports on an experiment conducted to study the effects of learner knowledge, case complexity (i.e. cases with or without a clear diagnosis) and their interaction on handover accuracy and cognitive load. METHODS: Participants were 52 Dutch medical students in Years 2 and 6...
September 2016: Medical Education
Cynthia Foronda, Brigit VanGraafeiland, Robert Quon, Patricia Davidson
BACKGROUND: The handover and transport of critically ill pediatric patients requires communication amongst multiple disciplines. Poor communication is a leading cause of sentinel events and human factors affect handover and transport. OBJECTIVES: To synthesize published data on pediatric handover and transport and identify gaps to provide direction for future investigation. METHODS: Integrative literature review. RESULTS: Forty research studies were reviewed and revealed the following themes: risk for patient complications, standardized communication, and specialized teams and teamwork were associated with improved outcomes...
October 2016: International Journal of Nursing Studies
Isotta Lorenzi, Silke Oeljeklaus, Christin Ronsör, Bettina Bareth, Bettina Warscheid, Peter Rehling, Sven Dennerlein
The three conserved core subunits of the cytochrome c oxidase are mitochondrial-encoded in close to all eukaryotes. The Cox2 subunit spans the inner membrane twice, exposing N- and C-terminus into the intermembrane space. For this the N-terminus is exported cotranslationally by Oxa1 and subsequently undergoes proteolytic maturation in Saccharomyces cerevisiae Little is known about the translocation of the C-terminus but Cox18 has been identified as a critical protein in this process. Here we find that the scaffold protein Cox20, which promotes processing of Cox2, is in complex with the ribosome-receptor Mba1 and translating mitochondrial ribosomes in a Cox2-dependent manner...
August 22, 2016: Molecular and Cellular Biology
Claudia T Matthaeus-Kraemer, Daniel O Thomas-Rueddel, Daniel Schwarzkopf, Hendrik Rueddel, Bernhard Poidinger, Konrad Reinhart, Frank Bloos
PURPOSE: The purpose was to identify barriers to the early detection and timely management of severe sepsis throughout the emergency department (ED), general ward (GW), intermediate care unit (IMC), and the intensive care unit (ICU). MATERIALS AND METHODS: Five multicenter focus group discussions with 29 clinicians were conducted. Discussions were based on a moderation guide were recorded and transcribed. Qualitative analysis was performed according to the principles of the concept mapping method and the framework approach...
July 9, 2016: Journal of Critical Care
Furqan B Irfan, Sameer A Pathan, Zain A Bhutta, Mohamed E Abbasy, Amr Elmoheen, Abdallah M Elsaeidy, Tooba Tariq, Charles D Hugelmeyer, Habib Dardouri, Noor Bibi Khial Bad Shah, Colene Y Daniel, Ashwin D Silva, Kaleelullah S Farook, Yogdutt Sharma, Stephen H Thomas
The State of Qatar experienced a sandstorm on the night of April 1, 2015, lasting approximately 12 hours, with winds of more than 100 km/h and average particulate matter of approximately 10 μm in diameter. The emergency department (ED) of the main tertiary hospital in Qatar managed 62% of the total emergency calls and those of higher triage order. The peak load of patients during the event manifested approximately 6 hours after the onset. The Major Emergency Command Centre of the hospital ensured the department was maximally organized in terms of disaster management, and established protocols were brought into action...
August 19, 2016: Disaster Medicine and Public Health Preparedness
Noa Segall, Alberto S Bonifacio, Atilio Barbeito, Rebecca A Schroeder, Sharon R Perfect, Melanie C Wright, James D Emery, B Zane Atkins, Jeffrey M Taekman, Jonathan B Mark
BACKGROUND: Patient handovers (handoffs) following surgery have often been characterized by poor teamwork, unclear procedures, unstructured processes, and distractions. A study was conducted to apply a human-centered approach to the redesign of operating room (OR)-to-ICU patient handovers in a broad surgical ICU (SICU) population. This approach entailed (1) the study of existing practices, (2) the redesign of the handover on the basis of the input of hand over participants and evidence in the medical literature, and (3) the study of the effects of this change on processes and communication...
September 2016: Joint Commission Journal on Quality and Patient Safety
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