Team performance in the operating theatre

Imperial Users onl

Interdisciplinary communication in the intensive care unit

Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample of 48 doctors and 136 nurses (47% response rate) from four ICUs responded to the survey. Nurses and doctors were found to have differing perceptions of interdisciplinary communication, with nurses reporting lower levels of communication openness between nurses and doctors. Compared with senior doctors, trainee doctors also reported lower levels of communication openness between doctors. A regression path analysis revealed that communication openness among ICU team members predicted the degree to which individuals reported understanding their patient care goals (adjR2 = 0.17). It also showed that perceptions of the quality of unit leadership predicted open communication. Conclusions. Members of ICU teams have divergent perceptions of their communication with one another. Communication openness among team members is also associated with the degree to which they understand patient care goals. It is necessary to create an atmosphere where team members feel they can communicate openly without fear of reprisal or embarrassment

The Effects Of Need-Based Aid On College Enrollment: An Analysis Of Institutions That Award College Promise Scholarships

People that obtain a college degree or certification are more likely to have an enhanced quality of life in areas of physical, mental, and financial well-being. The College Promise program promotes college enrollment by offering need-based scholarships with hopes that all students can obtain at least a two-year degree. Several scholars have examined the pre- and post-enrollment effects of College Promise programs on a per program basis, but no nationwide study exists that examines pre- and post-enrollment of institutions that award the scholarship. To determine the enrollment effect of College Promise programs, I examine the post-effect of enrollment among the award availability categories using a differences-in-difference model. When examining years when financial aid data were collected, the highest increase in total enrollment were among institutions that granted statewide and area-specific scholarships. This type of institution increased enrollment. Schools that exclusively granted statewide scholarships also increased in comparison to pre-College Promise enrollment averages. This shows that the College Promise programs have an effect, but the program availability type is particularly relevant

Communication in the operating theatre: A systematic literature review of observational research

Background: Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews. Methods: A systematic review of the literature for accessible published and grey literature was performed in July 2012. The following information was extracted: year, country, objectives, methods, study design, sample size, healthcare professional focus and main findings. Quality appraisal was conducted using the Critical Appraisal Skills Programme. A meta-ethnographic approach was used to categorize further the main findings under key concepts. Results: Some 1174 citations were retrieved through an electronic database search, reference lists and known literature. Of these, 26 were included for review after application of full-text inclusion and exclusion criteria. The overall quality of the studies was rated as average to good, with 77 per cent of the methodological quality assessment criteria being met. Six key concepts were identified: signs of effective communication, signs of communication problems, effects on teamwork, conditions for communication, effects on patient safety and understanding collaborative work. Conclusion: Communication was shown to affect operating theatre practices in all of the studies reviewed. Further detailed observational research is needed to gain a better understanding of how to improve the working environment and patient safety in theatre

Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom

Background Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures. Methods We conducted interviews with 20 senior multidisciplinary healthcare professionals from surgical teams in four major hospitals in the United Kingdom. The interviews explored the types of everyday pressures staff were experiencing, the strategies they use to adapt, and how these strategies might be taught to others. Results The primary pressures described by senior clinicians in surgery were increased numbers and complexity of patients alongside shortages in staff, theatre space and post-surgical beds. These pressures led to more difficult working conditions (e.g. high workloads) and problems with system functioning such as patient flow and cancellation of lists. Strategies for responding to these pressures were categorised into increasing or flexing resources, controlling and prioritising patient demand and strategies for managing the workload (scheduling for efficiency, communication and coordination, leadership, and teamwork strategies). Conclusions Teams are deploying a range of strategies and making adaptations to the way care is delivered. These findings could be used as the basis for training programmes for surgical teams to develop coordinated strategies for adapting under pressure and to assess the impact of different combinations of strategies on patient safety and surgical outcomes

Dielectric characterization and molecular interaction behaviour in binary mixtures of methyl acetate with 1-butanol and 1-pentanol

900-910The dielectric constant (ɛs) and relaxation time () of binary mixtures of methyl acetate with alcohols (1-butanol and 1-pentanol) have been investigated at fifteen molar concentrations over the entire mixing range at 288 K, 298 K, 308 K and 318 K using time domain reflectometery technique over the frequency range from 10 MHz to 10 GHz. The relaxation in these mixtures can be described by a single relaxation time using the Debye model. The concentration dependent plots of excess dielectric constant (ɛE), excess inverse relaxation time (1/)E, Kirkwood correlation factor (geff), thermodynamic parameters such as enthalpy of activation (H) and Gibbs free energy (G) of activation and Bruggman factor (fB) have been used to explore the complexes formed between unlike molecules, dipolar ordering, hydrogen bond molecular connectivity’s and their strength in the binary mixtures. Results confirm that there are strong hydrogen-bond interactions between unlike molecules of ester-alcohol mixtures

Dielectric characterization and molecular interaction behaviour in binary mixtures of methyl acetate with 1-butanol and 1-pentanol

The dielectric constant (ɛs) and relaxation time () of binary mixtures of methyl acetate with alcohols (1-butanol and 1-pentanol) have been investigated at fifteen molar concentrations over the entire mixing range at 288 K, 298 K, 308 K and 318 K using time domain reflectometery technique over the frequency range from 10 MHz to 10 GHz. The relaxation in these mixtures can be described by a single relaxation time using the Debye model. The concentration dependent plots of excess dielectric constant (ɛE), excess inverse relaxation time (1/)E, Kirkwood correlation factor (geff), thermodynamic parameters such as enthalpy of activation (H) and Gibbs free energy (G) of activation and Bruggman factor (fB) have been used to explore the complexes formed between unlike molecules, dipolar ordering, hydrogen bond molecular connectivity’s and their strength in the binary mixtures. Results confirm that there are strong hydrogen-bond interactions between unlike molecules of ester-alcohol mixtures

Adaptive strategies used by surgical teams under pressure:an interview study among senior healthcare professionals in four major hospitals in the United Kingdom

BackgroundHealthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures.MethodsWe conducted interviews with 20 senior multidisciplinary healthcare professionals from surgical teams in four major hospitals in the United Kingdom. The interviews explored the types of everyday pressures staff were experiencing, the strategies they use to adapt, and how these strategies might be taught to others.ResultsThe primary pressures described by senior clinicians in surgery were increased numbers and complexity of patients alongside shortages in staff, theatre space and post-surgical beds. These pressures led to more difficult working conditions (e.g. high workloads) and problems with system functioning such as patient flow and cancellation of lists. Strategies for responding to these pressures were categorised into increasing or flexing resources, controlling and prioritising patient demand and strategies for managing the workload (scheduling for efficiency, communication and coordination, leadership, and teamwork strategies).ConclusionsTeams are deploying a range of strategies and making adaptations to the way care is delivered. These findings could be used as the basis for training programmes for surgical teams to develop coordinated strategies for adapting under pressure and to assess the impact of different combinations of strategies on patient safety and surgical outcomes

Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: A realist process evaluation protocol

Background: Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design: We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders' theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery