Closed-loop Communication Research Articles

Development and testing of a resuscitation-specific measure of organizational culture for resuscitation teams

BackgroundThe organizational culture (shared beliefs, perceptions, and values) of teams informs their behaviours and practices. Little is known about organizational culture for resuscitation teams. Our objective was to develop a reliable and valid resuscitation-specific organizational culture instrument (ROCI) with the goal of improving team performance. MethodsUsing Neonatal Resuscitation Program principles, literature review, and discussion of existing culture measures with experts, we identified organizational culture components for resuscitation and adapted existing measures to resuscitation. We developed a ROCI with five subscales (role clarity, shared-mental models, closed-loop communication, team adaptability, and psychological safety) and administered it to neonatal resuscitation team members across a hospital network. Survey psychometric assessment included reliability analyses (Cronbach’s α, Pearson correlation coefficients) and validity testing (confirmatory factor analysis [CFA] and regression models examining the association of culture with implementation outcomes: climate and perceived success). ResultsAcross 11 hospitals there were 318 complete responses (41 % response rate). Of the 22-items tested, 18 were retained after iterative psychometric assessment. The ROCI had excellent overall reliability (Cronbach’s α = 0.994) and very good subscale reliability (Cronbach’s α = 0.789–0.867). The CFA goodness-of-fit statistics confirmed five constructs (subscales). At the individual-level, the ROCI and all subscales were associated with both implementation outcomes. At the hospital-level, the ROCI overall and three subscales were associated with perceived success. ConclusionThe ROCI is a reliable and valid measure of the organizational culture of resuscitation teams. Future ROCI assessments may provide a foundation to inform culture change initiatives to improve resuscitation quality and outcomes across populations and contexts.

Management of Plastic Surgery Complications at a Tertiary Medical Center after Aesthetic Procedures.

The aesthetic plastic surgery industry has seen tremendous growth, with Americans spending an estimated 20 billion dollars on procedures in 2020. However, the effect of complications from these procedures on the healthcare system is poorly understood. This study aims to create awareness regarding aesthetic procedure complications through the scope of plastic surgeons at a tertiary medical facility. A retrospective chart review was performed on patients who received care at a single academic tertiary referral center over 5 years for complications from a cash-paid aesthetic procedure at an outside facility. Physician and hospital billing data were analyzed for relevant encounters. Patients in this study (n = 40) presented to the emergency department most frequently with complications secondary to abdominoplasty (35%), breast augmentation (27.5%), and injectable fillers (17.5%). The most common complications were infection (32.5%) and wound dehiscence (22.5%). Of those evaluated, 50% required inpatient admission. Additionally, 42.5% required surgical intervention. The distribution of payors included Medicaid (55%), commercial insurance (30%), and Medicare (7.5%), and 7.5% were uninsured. For physician billing, the total gross collection ratio was 21.3%, whereas the hospital billing total gross collection ratio was 25.16%. Larger referral hospitals are well-suited to support the aesthetic community with complication management; however, the care required to serve this population is resource-intensive. These data advocate for thorough closed-loop patient-surgeon communication regarding risk-benefit analysis and detailed courses of action should complications arise. Likewise, stronger communication between ambulatory surgical centers and tertiary referral centers may also help minimize complications and subsequent healthcare needs.

Enhancing Team Dynamics and Leadership Skills for Residents Leading Multidisciplinary In-Patient Cardiac Arrest Teams

Background: Cardiac arrest is a prevalent event with low survival rates, both in out-of-hospital and in-hospital settings. There is a lack of specific training programs addressing team dynamics and leadership skills during resuscitation events, creating a clinical gap. This project aimed to enhance team dynamics and improve leadership skills during IHCA resuscitation events. Methods: We implemented the Mock Code Project for resident physicians from our Internal Medicine Residency Programs in the simulation center (i.e., in a controlled environment) to address this gap. Multidisciplinary team mock code scenarios were created for residents, allowing them to lead resuscitation simulations. The scenarios were based upon common conditions encountered during codes (Cardiac arrest). Trained evaluators provided real-time feedback, and pre-and post-surveys were conducted to assess team perception and gather feedback. Results: Baseline data revealed that 98.6% (143 of 145 residents total) felt uncertain or lacked confidence in leading effective codes in our hospital prior to the intervention. Post-test survey outcome data revealed that 95.1% of participants (136 residents of 143) reported that the sessions challenged their skills at leading codes and improved their skills at managing resuscitation teams. Conclusion: Organized codes with clear roles, responsibilities, bed positioning, and clear leadership significantly improve closed-loop communication, effective team interaction, and patient outcomes. The Mock Code Project fills the gap in training programs by focusing on team dynamics and leadership skills during IHCA resuscitation. Ongoing evaluations and feedback ensure continual improvement in resident confidence and skills. Implementing organized codes benefits residents and healthcare teams, ultimately improving patient care during IHCA. Well-designed mock code scenarios with real-time feedback from senior physicians are an effective way for trainees to develop these skills and this awareness without compromising patient safety.

CONNECT: Coordinating Options for Neurovascular Patients Needing Electrophysiology Consults and Treatments

Background and Purpose Though Event Monitors (EM) and Implantable Loop Recorders (ILR) are prevalent in stroke workups, complex processes to obtain placement of these device might result in delays. Our aim was to determine if the CONNECT (Coordinating Options for Neurovascular patients Needing Electrophysiology Consults and Treatments) pathway could improve Stroke-to-Electrophysiology (EP) communications, increase EM and ILR device placements prior to discharge, shorten placement time, and preserve satisfaction. Methods We assessed device placements when an EP consult was obtained [Pre-CONNECT (5/1/21-4/30/22), CONNECT (5/1/22-4/30/23)] for patients with stroke. In the Pre- period, consults were sent via EPIC electronic medical record (EMR), with additional direct communication when desired. In the CONNECT period, the pathway and module allowed for immediate communication between services. Outcomes included case rate, times, length of stay, and satisfaction. Hospital reports detailed Order to Activation (O-A) days. EM report review was used to obtain O-A time. Clinician satisfaction was assessed using Qualtrics survey. Patient satisfaction was assessed with Hospital Consumer Assessment of Health care Clinicians and Systems (HCAHPS) survey. Man-Whitney U test was used. Results 78 patients were included (30EM(38.5%), 48ILR(61.5%)). Age was 68 years ( P = 0.58). For ILRs, inpatient placements prior to discharge increased (3Pre vs 51 CONNECT; P < 0.0001) as did outpatient placements (5 vs 16; P = 0.02). Order to Activation (O-A) time savings were significant for ILR overall (32 days vs 1 day; P = 0.03) and for Inpatient EM (13 days vs 3 days; P = 0.003). Time for consultant to view was 4 min and to respond was 6 min. Devices were placed at a median 6 hrs 32 min (EM: 4 hrs 19 min; ILR:7 hrs36 min). All (12/12) clinicians preferred the technique. Patient satisfaction improved on 13/19 (68%) questions. Conclusions There was a 1600% increase in ILR placements prior to discharge that was associated with the time period that the CONNECT process was in place. The robust improvement in ILR placements prior to discharge, high satisfaction, ease of use, closed loop communication, and respect for autonomy allowing more organic parallel discussions with patients improved clinician workflow which could potentially improve future risk reduction strategies.

Abstract C132: Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles

Abstract Introduction: Multilevel barriers to screening and follow-up contribute to persistent disparities in cervical cancer burden, particularly in marginalized communities receiving care in safety-net healthcare settings. While evidence-based interventions (EBIs) exist for improving cancer screening and follow-up, building capacity to identify effective strategies for implementation and alignment of EBIs to the context of safety-net settings and the diverse communities they serve is critical. Methods: Supported by the HRSA Accelerating Cancer Screening Program, Chinatown Service Center, a multi-site Federally Qualified Health Center (FQHC) serving Chinese and Latino/a populations in Los Angeles, and USC Norris Comprehensive Cancer Center established a new partnership to identify multilevel factors that impact cervical cancer screening, follow-up and referral and inform the implementation of EBIs to improve care. We conducted a mixed methods assessment June-December 2023 to understand care processes through surveys and qualitative interviews (20-30 minutes, guided by the Consolidated Framework for Implementation Research) with providers and clinic staff and medical chart reviews of patients with ≥ 1 cervical cancer screening order January 2020-March 2023. Results: Surveys (n=23) showed higher knowledge of screening guidelines (p<0.05) and more confidence discussing cervical cancer with patients (p<0.05) among providers compared to clinic staff, indicating opportunities for staff training. Qualitative interviews (n=23) identified inner setting barriers such as limited system-level implementation of cervical cancer screening guidelines and limited technology supports to track patients requiring follow-up. At the individual level, older patients and those not sexually active often declined testing and requested gender concordant (female) providers. Motivation for building cervical cancer care capacity within the FQHC were noted, with clinic members highlighting FQHC strengths in addressing cultural barriers, social needs, and community outreach. Several outer setting barriers emerged for referral and follow-up care, including long wait times for referrals, trouble finding language concordant specialists, transportation barriers, and difficulty accessing specialists through their managed care network. Medical chart abstractions (n=1,428) identified opportunities to improve closed-loop communication with specialists and limited ease for clinic staff identify high and low risk screening results for further treatment. Discussion: By establishing a new FQHC-NCI cancer center partnership, we advanced our combined capacity to address cervical cancer care equity in marginalized communities. We identified patient-level (cultural, logistic, social determinants), provider/clinic staff-level (training needs, patient tracking), and system-level (access to and communication with specialists) barriers that will require selection of EBIs and implementation strategies via a partnered approach with local specialists, health systems, payers, and policymakers. Citation Format: Jennifer Tsui, Samantha Garcia, Emily Dang, Alejandra Ramos, Allison Oh, Kathy Lui, Angela Ching, Eugene Hui, Chanita Hughes Halbert, Lourdes Baezconde-Garbanati, Jack Cheng. Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C132.

Abbreviated in-situ inter-professional debriefing simulation training in peri-operative care environments: Minimizing the impact on clinical care using standardized videos

IntroductionOur facility leadership posed questions to the perioperative leadership team regarding the presence of collaborative communication during the reconciliation of events occurring in several perioperative care areas (operating rooms {OR}, clinic procedure areas, Intensive Care Unit {ICU}). Our team* collaborated to pilot a rapid cycle performance improvement project focused on improving the effectiveness of debriefings and handoffs that could conceivably lead to more effective after-action reviews following events which were complicated by multiple simultaneous unexpected factors. We proposed we could implement standardized abbreviated low-fidelity point of care (in-situ) inter-professional simulation training across the healthcare system with minimal impact on clinical schedules. We believed this would improve the perception of teamwork and collaboration among surgical team members. MethodsInter-professional in-situ simulation training exercises were designed and performed in perioperative care areas systemwide at our three major facilities (Main hospital and two Healthcare Community Centers [HCC]). Multiple iterations of styles of training were conceived and trialed. In the end, preconstructed videos were used to standardize the processes that framed the simulation role-playing of a debriefing after a complex situation. These videos contain the pre-simulation pre-briefings, the clinical situation that preceded the clinical debriefing and the simulation debriefing. Successful reconciliation of the multiple events required team members to exercise closed-loop communication, mutual trust, reengagement, and de-escalation of disengaged team members. Anonymous institutional review board reviewed, and Association of Federal Government Employees (AFGE) approved retrospective pre/post implementation surveys were made available to participants immediately after and sixty to ninety days following simulation exercises. ResultsBetween July 2023 and March 2024, one hundred and six staff in the perioperative care areas participated in twenty-two inter-professional simulation trainings (eleven OR, eight clinic, and three ICU simulations). Fourteen simulation scenarios in seven surgical disciplines were created. Eleven videos were produced covering cases in the O.R., clinic and ICU. Ultimately, the simulations were completed within twenty minutes in the three perioperative care clinical areas. Seventy-nine staff responded to the initial surveys after the simulation training. Eighty percent of the respondents gave favorable assessments regarding the effectiveness of the training in improving components of teamwork and agreed this program should continue. ConclusionsThe pilot program affirmed that we could implement simulations across the healthcare system in a format that minimally impacted the staffs’ clinical schedule. The process was standardized through the creation of multiple specialty specific videos. We proposed that perioperative team leadership could utilize these videos in the future to conduct spontaneously arranged simulations when they identified the presence of members naïve to this training and opportunities in the clinical schedule.*Refer to the acknowledgments for construct of our perioperative leadership simulation advisory team

A qualitative study of providers’ perspectives on cross-institutional care coordination for pancreatic cancer: challenges and opportunities

BackgroundDespite calls for regionalizing pancreatic cancer (PC) care to high-volume centers (HVCs), many patients with PC elect to receive therapy closer to their home or at multiple institutions. In the context of cross-institutional PC care, the challenges associated with coordinating care are poorly understood.MethodsIn this qualitative study we conducted semi-structured interviews with oncology clinicians from a HVC (n = 9) and community-based hospitals (n = 11) to assess their perspectives related to coordinating the care of and treating PC patients across their respective institutions. Interviews were transcribed, coded, and analyzed using deductive and inductive approaches to identify themes related to cross-institutional coordination challenges and to note improvement opportunities.ResultsClinicians identified challenges associated with closed-loop communication due, in part, to not having access to a shared electronic health record. Challenges with patient co-management were attributed to patients receiving inconsistent recommendations from different clinicians. To address these challenges, participants suggested several improvement opportunities such as building rapport with clinicians across institutions and updating tumor board processes. The opportunity to update tumor board processes was reportedly multi-dimensional and could involve: (1) designating a tumor board coordinator; (2) documenting and disseminating tumor board recommendations; and (3) using teleconferencing to facilitate community-based clinician engagement during tumor board meetings.ConclusionsIn light of communication barriers and challenges associated with patient co-management, enabling the development of relationships among PC clinicians and improving the practices of multidisciplinary tumor boards could potentially foster cross-institutional coordination. Research examining how multidisciplinary tumor board coordinators and teleconferencing platforms could enhance cross-institutional communication and thereby improve patient outcomes is warranted.

Classification and Communication of Critical Findings in Emergency Radiology: A Scoping Review

PurposeTo identify the published standards for the classification and communication of critical actionable findings in emergency radiology and the associated facilitators and barriers to communication and message management or dissemination of such findings. Materials and methodsSearch terms for resources pertaining to critical findings (CFs) in emergency radiology were applied to two databases (PubMed, Embase). Screening of hits using the following pre-established inclusion and exclusion criteria were performed by three analysts with subsequent consensus discussion for discrepancies: (1) the resources include any standards for the classification and communication of imaging findings as critical, or (2) the resource discusses any facilitators to the communication of CFs, or (3) the resource discusses any barriers to the communication of CFs. Resources with explicit focus on a pediatric population or predominant focus on artificial intelligence or natural language processing were omitted. Accompanying gray literature search was used to expand included resources. Data extraction included year, country, resource type, scope or purpose, participants, context, standards to identifying or communicating CFs, facilitators and barriers, method type, recommendations, applicability, and disclosures. ResultsSeventy-six resources were included in the final analysis, including 16 societal or commission guidelines. Among the guidelines, no standardized list of CFs was identified, with typical recommendations suggesting application of a local policy. Communication standards included direct closed-loop communication for high acuity findings, with more flexible communication channels for less acute findings. Applied interventions for CFs management most frequently fell into four categories: electronic (n = 10), hybrid (ie, electronic or administrative) (n = 3), feedback or education (n = 5), and administrative (n = 4). ConclusionThere are published standards, policies and interventions for the management of CFs in emergency radiology. Three-tier stratification (eg, critical, urgent, incidental) based on time sensitivity and severity is most common with most CFs necessitating closed-loop communication. Awareness of systemic facilitators and barriers should inform local policy development. Electronic and administrative communication pathways are useful adjuncts. Further research should offer comparative analyses of different CF interventions with regards to cost-effectiveness, notification time, and user feedback.

Optimizing Pediatric Rapid Response Teams: Stakeholder Focus Groups.

Rapid response teams (RRTs) can improve outcomes in both adult and pediatric hospitals. Most pediatric hospitals have RRT-type systems; however, little is known about stakeholders' perspectives regarding how to optimize RRT quality and efficiency. We aimed to better understand multidisciplinary stakeholder perspectives on how to improve the RRT process. We held 4 stakeholder focus groups including floor nurses, pediatric trainees (interns and residents), pediatric hospitalists, and the responding PICU team (PICU fellows and nurses). We used deductive coding to identify potential solutions and subsequent themes. Focus groups identified 10 potential solutions within 3 major themes. Themes included (1) the value of a standardized RRT workflow based on stages, (2) the benefit of promoting a safety culture, and (3) the need to implement ongoing RRT education. Stakeholders described a shared mental model of RRT workflow with important events or tasks occurring within each stage. These stages were coded as 1: trigger, 2: team arrival and information sharing, 3: intervention, and 4: disposition and follow-up. Additional proposed solutions included waiting for the entire team to arrive, a systematic information sharing process, and closed loop communication for follow-up plans for patients remaining on the general care floor. RRT stakeholder focus groups provide valuable insight into efforts to optimize RRT events. Standardizing RRT workflow into a staged process may facilitate communication and information sharing. Promoting a culture of safety and implementing ongoing education may help reinforce RRT standardization.

A potentially lifesaving error: unintentional high-dose adrenaline administration in anaphylaxis-induced cardiac arrest; a case report

BackgroundCardiopulmonary resuscitation is a crucial skill for emergency medical services. As high-risk-low-frequency events pose an immense mental load to providers, concepts of crew resource management, non-technical skills and the science of human errors are intended to prepare healthcare providers for high-pressure situations. However, medical errors occur, and organizations and institutions face the challenge of providing a blame-free error culture to achieve continuous improvement by avoiding similar errors in the future. In this case, we report a critical medical error during an anaphylaxis-associated cardiac arrest, its handling and the unexpected yet favourable outcome for the patient.Case presentationDuring an out-of-hospital cardiac arrest due to chemotherapy-induced anaphylaxis, a patient received a 10-fold dose of epinephrine due to shortcomings in communication and standardization via a central venous port catheter. The patient converted from a non-shockable rhythm into a pulseless ventricular tachycardia and subsequently into ventricular fibrillation. The patient was cardioverted and defibrillated and had a return of spontaneous circulation with profound hypotension only 6 min after the administration of 10 mg epinephrine. The patient survived without any residues or neurological impairment.ConclusionsThis case demonstrates the potential deleterious effects of shortcomings in communication and deviation from standard protocols, especially in emergencies. Here, precise instructions, closed-loop communication and unambiguous labelling of syringes would probably have avoided the epinephrine overdose central to this case. Interestingly, this serious error may have saved the patient’s life, as it led to the development of a shockable rhythm. Furthermore, as the patient was still in profound hypotension after administering 10 mg of epinephrine, this high dose might have counteracted the severe vasoplegic state in anaphylaxis-associated cardiac arrest. Lastly, as the patient was receiving care for advanced malignancy, the likelihood of termination of resuscitation in the initial non-shockable cardiac arrest was significant and possibly averted by the medication error.

Perspectives on supporting Veterans’ social needs during hospital to home health transitions: findings from the Transitions Nurse Program

BackgroundVeterans who need post-acute home health care (HHC) are at risk for adverse outcomes and unmet social needs. Veterans’ social needs could be identified and met by community-based HHC clinicians due to their unique perspective from the home environment, acuity of Veterans they serve, and access to Veterans receiving community care. To understand these needs, we explored clinician, Veteran, and care partner perspectives to understand Veterans’ social needs during the transition from hospital to home with skilled HHC.MethodsQualitative data were collected through individual interviews with Veterans Health Administration (VHA) inpatient & community HHC clinicians, Veterans, and care partners who have significant roles facilitating Veterans’ hospital to home with HHC transition. To inform implementation of a care coordination quality improvement intervention, participants were asked about VHA and HHC care coordination and Veterans’ social needs during these transitions. Interviews were recorded, transcribed, and analyzed inductively using thematic analysis and results were organized deductively according to relevant transitional care domains (Discharge Planning, Transition to Home, and HHC Delivery).ResultsWe conducted 35 interviews at 4 VHA Medical Centers located in Western, Midwestern, and Southern U.S. regions during March 2021 through July 2022. We organized results by the three care transition domains and related themes by VHA, HHC, or Veteran/care partner perspective. Our themes included (1) how social needs affected access to HHC, (2) the need for social needs screening during hospitalization, (3) delays in HHC for Veterans discharged from community hospitals, and (4) a need for closed-loop communication between VHA and HHC to report social needs.ConclusionsHHC is an underexplored space for Veterans social needs detection. While this research is preliminary, we recommend two steps forward from this work: (1) develop closed-loop communication and education pathways with HHC and (2) develop a partnership to integrate a social risk screener into HHC pathways.

Expedited Exome Reanalysis Following Deep Phenotyping and Muscle Biopsy in Suspected Mitochondrial Disorder

BackgroundExome sequencing (ES) is a useful tool in diagnosing suspected mitochondrial disease but can miss pathogenic variants for several reasons. Additional testing, such as muscle biopsy or biochemical testing, can be helpful in exome-negative cases. MethodsWe report a patient who presented with repeated episodes of lactic acidosis and failure to thrive. ResultsES and mitochondrial sequencing were initially negative but clinical suspicion for mitochondrial disease remained high. After muscle biopsy showed evidence of mitochondrial dysfunction, the ES was reanalyzed and revealed novel variants in AARS2. ConclusionThis case demonstrates the importance of muscle biopsy and biochemical testing in evaluating patients with a high suspicion of mitochondrial disease, even in the genomics era. Closed-loop communication between molecular genetics laboratories and clinical geneticists is an important step to help establish diagnosis in unsolved cases.

The importance of the team in small animal CPR

This review draws on evidence from human medicine to assess the team factors most relevant to small animal cardiopulmonary resuscitation (CPR). It is increasingly being recognised that leadership, team building, communication and situational awareness all impact both the team's experience and clinical outcomes. Leadership training, nurse-led teams, debriefing, closed-loop communication and cognitive aids have all been shown to improve CPR performance and thus deserve consideration alongside the practical elements of arrest and resuscitation. There is limited primary evidence to support this claim in veterinary medicine. However, the mental models underpinning clinical human factors are largely seen as transferable, with veterinary governing bodies supporting their inclusion in practice culture and training.

Effect of simulation-based training workshop on obstetric emergency team collaboration and communication: a mixed study.

To explore the effects of simulation-based midwife training workshops and determine whether such a program can improve team collaboration and communication. Simulation training improves communication, team cooperation, critical thinking, and situational awareness. This mixed study was conducted September 15-18, 2021. Participants included 23 obstetricians and midwives who completed 2 days of simulation training, including communication, skills, teamwork, single technical operation, and scene running. The Clinical Teamwork Scale was used before and after the comparison, and the data were analyzed using a phenomenological analytic process. The total team cooperation, transparent thinking, closed-loop communication, overall decision-making, clear responsibility, and leadership scores of the trainees were significantly higher after than before the training. The experience of attending a simulated training workshop can be divided into two themes: innovative ways of offering training and active learning. Three key themes emerged from each category: education combined with recreation; full participation in interactions; and teamwork and communication. (1) application of knowledge (2) dissemination, and (3) sublimation of knowledge. This study's findings indicated a good experience and higher team cooperation score among midwives participating in simulation-based training in China, the value of our work is to show that the researched teaching methods, although published in other contexts, are also valuable in the Chinese context, suggesting that they will pass on the methods and concepts of the simulated training to others and change the current status of classroom teaching, which is its most meaningful practical training effect. These results imply that simulation-based midwife training for obstetric emergencies is required to improve the comprehensive ability of midwives to address obstetric emergencies, thereby improving maternal clinical outcomes. Neither patients nor the public were involved in this study, and the midwives and obstetricians voluntarily participated.

Enhancing interprofessional collaboration in paediatric training: Insights from profession-specific experiences and implications for future education.

There is limited evidence on trainees' and instructors' needs and perspectives concerning interprofessional simulation-based trainings. We aimed to study task distribution among team members, profession-specific learning effects and enhancing collaboration and competencies within medical teams. This prospective study examined expectations and experiences of medical and nursing students during paediatric emergency training in a tertiary care centre with questionnaires before and after a training. Further, expert interviews were conducted to identify the needs for interprofessional training. Results were used to design a standardised checklist for structured preparation of interprofessional paediatric emergency management training. Of the nursing students, 82% initially intended to assume the role of the team leader, but only 5.8% did so during training. Both professions emphasised the significance of effective communication and transparent task distribution for successful collaboration. Experts highlighted the importance of proficiency in basic technical skills and identified non-technical skills such as closed-loop communication and the 10-4-10 principle as crucial for both professions. The study revealed profession-specific variations in the intention of acquiring the team leader or member role. Interprofessional training emerges as a potential strategy to dismantle these structures and promote shared responsibilities. The checklist aims to facilitate structured preparation of a training.

Interprofessional Paediatric High-Fidelity Simulation Training: A Mixed Methods Study of Experiences and Readiness among Nursing and Medical Students.

Training in communication skills between nursing and medical students during interprofessional paediatric emergency simulation training represents a significant aspect of safe patient care. Evidence highlights that poor communication in paediatric emergency scenarios jeopardises patient safety. Through realistic simulations, students practice the communication strategies of crisis resource management (CRM), such as "closed-loop communication", "speaking up", and "team time-out". In this study, we aimed to evaluate the impact of interprofessional simulation on enhancing teamwork and communication skills. Additionally, we sought to assess the occurrence of contexts for the three CRM communication strategies during simulations. Employing a mixed methods research design, the analysed students completed pre- and post-simulation online questionnaires. To measure attitudes towards interprofessional collaboration, we used the German version of the University of West England Interprofessional Questionnaire (UWE-IP_german), and to measure interprofessional attitudes, we used the Greifswald Questionnaire for the Measurement of Interprofessional Attitudes (Greif Mie), also in German, for both pre- and post-simulation. For qualitative video analysis, we utilised Grounded Theory Methodology (GTM). Following simulation training, we observed a significant improvement (p > 0.001) in the subscale "attitude towards interprofessional learning" of the UWE-IP_german among nursing and medical students. Medical students consistently exhibited a significantly (p < 0.001) more positive attitude towards other professionals in both the pre- and post-simulation assessments. Overall, all the students expressed satisfaction with the interprofessional simulation training. In the qualitative selective coding process, the central phenomenon "participation" could be identified in the coding paradigm. This study presents substantial evidence of the learning impact of interprofessional paediatric simulation training on nursing and medical students.

An automated content-based measure of closed loop communication among critical care air transport teams.

Successful teamwork is essential to ensure critical care air transport (CCAT) patients receive effective care. Despite the importance of team performance, current training methods rely on subjective performance assessments and do not evaluate performance at the team level. Researchers have developed the Team Dynamics Measurement System (TDMS) to provide real-time, objective measures of team coordination to assist trainers in providing CCAT aircrew with feedback to improve performance. The first iteration of TDMS relied exclusively on communication flow patterns (i.e., who was speaking and when) to identify instances of various communication types such as closed loop communication (CLC). The research presented in this paper significantly advances the TDMS project by incorporating natural language processing (NLP) to identify CLC. The addition of NLP to the existing TDMS resulted in greater accuracy and fewer false alarms in identifying instances of CLC compared to the previous flow-based implementation. We discuss ways in which these improvements will facilitate instructor feedback and support further refinement of the TDMS.

Abstract WP40: Enhanced Team Communication Improves Door to Device Times

Background: Patients experiencing acute ischemic stroke benefit from early reperfusion. The American Heart Association set a goal for hospitals performing mechanical thrombectomy to achieve ‘door to device’ (DTD) time of less than 90 minutes for 50% of eligible patients. In 2021, only 23% of patients were meeting this time target. These patients require complex care and timely communication between various practitioners. It was noted that these practitioners were working in silos, which resulted in unnecessary delays. The need for enhanced communication was identified as an intervention to improve performance. Methods: Key team members are equipped with a dedicated phone using an artificial intelligence application, which provides an early signal when large vessel occlusion is detected. This allows for earlier mobilization of resources. This is particularly important for emergency department and interventional radiology nurses who are the ones driving transition of care between departments. In addition, the anesthesia department uses closed loop communication to notify the team of their readiness to receive the patient. Lastly, timely debriefs for all practitioners involved in the case provide a forum for constructive, thoughtful feedback about ways to be more efficient. Results: After enhanced communication strategies were implemented in quarter 2 of 2022, DTD times improved to 43% in quarter 3 of 2022, 50% in quarter 4 of 2022, 67% in quarter 1 of 2023 and 75% in quarter 2 of 2023. Conclusions: Providing tools to enhance communication amongst various practitioners has resulted in sustained improvement in DTD times. Future data collection should focus on associating these improved DTD times with long term functional outcomes.

Reliability of the safety threats and adverse events in trauma (STAT) taxonomy using trauma video review.

The STAT (Safety Threats and Adverse Events in Trauma) taxonomy was developed through expert consensus, and groups 65 identified trauma resuscitation adverse events (AEs) into nine distinct categories. It provides a framework for standardized analysis of trauma resuscitations and creates a foundation for targeted quality improvement and patient safety initiatives. This study aims to evaluate the reliability of the STAT taxonomy in identifying AEs during video-recorded trauma resuscitations. High-definition audiovisual data from 30 trauma resuscitations were reviewed. Videos were assessed and scored by four independent reviewers (two trainees and two staff). The STAT taxonomy was used to identify AEs based on binary responses: yes and no. Inter-rater reliability was calculated using Gwet's AC1. The frequencies of AEs were tallied and reported as counts and percentages. The most common AEs identified in the videos were failure to measure temperature (86.7%) and inadequate personal protective equipment (86.7%), followed by inability to use closed-loop communication (76.7%). The agreement on all AEs between reviewers was 0.94 (95% CI: 0.93-0.95). The Gwet's AC1 agreement across the 9 AE categories was paramedic handover (0.82), airway and breathing (0.99), circulation (0.95), assessment of injuries (0.91), management of injuries (0.96), procedure-related (0.97), patient monitoring and IV access (0.99), disposition (0.98), team communication and dynamics (0.87). The STAT taxonomy demonstrated excellent inter-rater reliability between reviewers and can be used to identify AEs in video-recorded trauma resuscitations. These results provide a foundation for adapting video review to objectively quantify and assess AEs in the trauma bay.

Feasibility of social network analysis to study outcomes of children with medical complexity.

Since most care for children with medical complexity (CMC) is delivered daily in communities by multiple caregiving individuals, that is, caregiving networks, tools to assess and intervene across these networks are needed. This study evaluated the feasibility of applying social network analysis (SNA) to describe caregiving networks. Because hospitalization is among the most frequently used outcomes for CMC, exploratory correlations between network characteristics and CMC hospital use were evaluated. Within 3 weeks, the goal network enrollment was achieved, and all feasibility measures were favorable. Network characteristics correlated with hospital use, that is, smaller, denser networks, with more closed-loop communication correlated with fewer hospital days. Networks with more professional caregivers also correlated with fewer hospital days. SNA is a feasible tool to study CMC caregiving networks. Preliminary data support rigorous hypothesis testing using SNA methods. Network-based interventions to improve CMC health may be an important future direction.