Experience Of Medical Staff Research Articles

Application of failure mode and effects analysis to optimization of linac quality controls protocol.

To apply Failure Mode and Effects Analysis (FMEA) to optimize linac quality control (QC) protocol in order to ensure patient safety and treatment quality, taking maximum advantage of the available resources. Each parameter tested by the QC was considered as a potential failure mode (FM). For each FM, likelihood of occurrence (O), severity of effect (S), and lack of detectability (D) were evaluated and corresponding Risk Priority Number (RPN) was calculated from the product of three indexes. The scores were assigned using two methods: (a) A survey submitted to the medical physicists; (b) A semi-quantitative analysis (SQA) performed through: simulation of FMs in the treatment planning system; studies reported in literature; results obtained by the QC data analysis. A weighted RPN for all FMs was calculated taking into account both the methods. For each linac, the tests were then sorted by their frequency and the RPN value. A high variability was found in the scores of the survey, although in many it was reduced in RPN values, highlighting the more relevant tests as on beam output and imaging system. Integrating these results with those obtained by SQA, the RPN-based ranking of tests has been provided considering the specific use of the accelerator: for example, more accurate tests on dose modulation and multileaf collimator speed were required in linacs where intensity-modulated treatment is performed, while, more specific tests on couch and jaw position indicators were necessary where treatments with multiple isocenters and/or junctions between adjacent fields were often delivered. Failure Mode and Effects Analysis is a useful tool to prioritize the linac QCs, taking into account the specific equipment and clinical practice. The integration of SQA and survey results reduces subjectivity of the FMEA scoring and allows to optimize linac QCs without "losing" the expertise and experience of medical physicists and clinical staff.

The ‘SAFE’ initiative – An innovative approach to safer patient care in a tertiary hospital setting

Introduction: Out of hours inpatient care within Australia, defined as the hours outside of 0800 to 1600 hours Monday to Friday, is traditionally provided by on-call medical teams, working in silos, supported by onsite junior medical staff. This model can be associated with poor communication both between and within teams, lack of accountability, failure of escalation, and a reactive model of care. International literature reveals that the outcomes of patients admitted to hospital out of hours are poorer, resulting in a discrepancy in mortality between in and out of hours admissions.Methods: We aimed to reduce the discrepancy in mortality between in and out of hours admissions, as well as reducing overall inpatient mortality. Using a resilience engineering approach, we introduced a novel model of out of hours care - the ‘Safety After Hours for Everyone’ (SAFE) Team. This incorporated a departmental model, with clear and robust internal leadership, external accountability, and formal processes for identification, review and follow up of at risk patients, as well as protocolised escalation processes.Results: The introduction of the SAFE model has been associated with a continuous reduction in the overall Hospital Standardised Mortality Ratio (HSMR) from 0.71 to 0.54 (periods January to March 2015 vs January to March 2018. In addition, the SAFE model has been associated with a reduction in out of hours mortality (defined as admissions from 1600 to 0800) from 0.98 to 0.38 (periods January to March 2015 vs January to March 2018). This has been accompanied by a qualitative improvement in the quality of care delivered out of hours, and improved satisfaction with working conditions and training delivered out of hours. Due to a drastic reduction in unplanned Resident Medical Officer (RMO) overtime associated with the introduction of the model, implementation was near cost neutral.Conclusion: The introduction of the SAFE model has been associated with improved hospital outcomes, in conjunction with improved medical and nursing staff experiences, at a low marginal cost. This model has scope to be applied to similar tertiary level hospitals, or modified to fit within most hospital structures. A key component to the success of this model’s innovation, is acknowledgement of the importance of after hours care provision to patients, highlighted by the formation of a department of after hours medicine as part of the SAFE model.

The Medical Supplies KIT Design based on the Intravenous Fluid Therapy for Experience of Medical Staff

The Medical Supplies KIT Design based on the Intravenous Fluid Therapy for Experience of Medical Staff

Incorporating work experience of medical staff into patient safety climate management: a multi-group analysis

BackgroundThis study aims to provide insights on how to incorporate the work experience of medical staff into safety climate management based on the relationships among several safety-related constructs such as teamwork climate, working condition, and job satisfaction.MethodsA cross-sectional study was conducted in a regional hospital in Taichung City, Taiwan using a Safety Attitude Questionnaire (SAQ)-based questionnaire. The relationships among the constructs were modeled by a structural equation model, and a multi-group analysis was performed. Among the employees participating in the survey, only physicians and nurses were considered in the analysis, accounting for 1596 out of 2277 responses. The key measures were the difference between the unconstrained and fully constrained structural models, the statistically different coefficients, and their strengths across the high and low-experience groups.ResultsOur multi-group analysis showed that the effects of management leadership on job satisfaction and of teamwork climate on safety climate were statistically stronger for low-experience medical staff, whereas the effect of working conditions on safety climate was statistically stronger for high-experience medical staff.ConclusionsThe findings demonstrate how to incorporate the work experience of medical staff into safety climate management. In summary, by focusing on different safety constructs for the less and more experienced staff—job satisfaction and teamwork climate for the less experienced, working conditions for the more experienced—management may be able to improve the organizational safety climate. Our suggestions in this study can be leveraged, should management implement the initiatives and action plans for safety climate improvement.

Opinions of pediatric nurses about Jehovah’s Witnesses refusal of blood transfusion for their child

Abstract Introduction. Jehovah’s Witnesses absolutely refuse having blood transfusion performed. The situation is even more difficult when the refusal of blood transfusion concerns a child. Despite existing legal solutions, medical staff experiences value conflicts. Aim. To analyze the opinions of pediatric nurses about problems that may arise in case of Jehovah’s Witnesses refusal of blood transfusion for their child. Material and methods. Quantitative research was based on a diagnostic survey method. The variables were measured with the use of a survey questionnaire co-developed by the authors. A group of 104 pediatric nurses from the South-East Poland participated in the study. Results. To the question “Have you ever encountered the situation throughout all your working career when parents refused their child to undergo a blood treatment due to their beliefs?”, 67.31% (n = 70) of the respondents replied the situation rarely happened. Half of the nurses surveyed (n = 52, 50.02%) admitted they did not accept the position of Jehovah’s Witnesses concerning blood treatment. Most of the nurses surveyed – 87.38% (n = 89) think the existence of procedures on how to proceed in this difficult situation is crucial, and 83% (n = 86) of the respondents admitted that there was no better solution than the already existing legal procedure. Conclusions. The most difficult experience of pediatric nurses in the situation of Jehovah’s Witnesses refusal of blood transfusion for their child is in the opinion of surveyed nurses, endangering the child’s health or even life. Thus, most of the respondents agree that the best solution in that case is to implement a legal procedure that allows blood transfusion despite parents’ refusal.

Professional Stress and Burnout in U.S. Military Medical Personnel Deployed to Afghanistan.

Studies of medical staff members have consistently documented high levels of burnout compared to those in other professions. Although there are studies of burnout in military medical staff, there are gaps in understanding the experience of medical staff while they are deployed and few occupationally-related factors associated with decreased burnout have been identified in this population. To assess work-related variables accounting for burnout over and above rank, post-traumatic stress disorder (PTSD) symptoms, and professional stressors in the deployed environment. U.S. military medical staff members were surveyed in Afghanistan. The survey assessed burnout (emotional exhaustion and depersonalization), PTSD symptoms, perception of professional stressors, self-care behaviors, taking care of team members (team care), general leadership, and health-promoting leadership. Participants provided informed consent under a protocol approved by the institutional review board at Walter Reed Army Institute of Research, and coordinated through the Washington Headquarters Service and the Joint Casualty Care Research Team located in Afghanistan. A total of 344 individuals provided their consent (83.3%) and completed the survey. Correlations found significant positive relationships between perception of professional stressors and levels of burnout. Significant negative correlations were found between burnout and self-care, team care, general leadership, and health-promoting leadership. Regression analyses found self-care and team care accounted for less burnout even after controlling for rank, PTSD symptoms, and professional stressors. Health-promoting leadership accounted for less burnout even after controlling for these same covariates and general leadership as well. Although a cross-sectional survey, results provide three specific directions for reducing burnout in deployed medical staff. By emphasizing self-care, team care, and health-promoting leadership, policy makers, researchers, and leaders can address factors that influence burnout in this, and other occupational contexts. In addition, the constructs of team care and leadership offer novel contributions to the study of burnout in medical personnel.

Professionalism of Healthcare Jobs in the War

Background: Professionalism is an important characteristic of professional jobs including nursing and medicine. Many professional values during the crisis are glaring. Objectives: This study was conducted to explain the role of the Iran-Iraq war in the professionalism of healthcare disciplines based on the documented experiences of medical staff. Methods: This is part of a qualitative study which used the conventional content analysis in 2014 - 2016. The researcher collected and analyzed 119 memories of the healthcare providers about the Iran-Iraq war, simultaneously. Results: Professionalism was one of the main categories emerged from the analysis of data. This theme included six sub-themes, “promotion of personal and professional empowerment”, “compliance with laws and regulations”, “holistic care”, “expression of good traits”, “interpersonal relationships”, and “sublimation of spirit”. Conclusions: Experiences of healthcare providers in the war can be applied in peacetime and future crisis through broadening their perception of nursing and medicine professions and improving their sense of professionalism.

Staff Responses When Parents Hit Children in a Hospital Setting.

Physical punishment of children is a prevalent practice that is condemned by most medical professionals given its link with increased risk of child physical abuse and other adverse child outcomes. This study examined the prevalence of parent-to-child hitting in medical settings and the intervention behaviors of staff who witness it. Staff at a children's medical center and a general medical center completed a voluntary, anonymous survey. We used descriptive statistics to examine differences in the experiences of physicians, nurses, and other medical staff. We used logistic regression to predict intervention behaviors among staff who witnessed parent-to-child hitting. Of the hospital staff who completed the survey (N = 2863), we found that 50% of physicians, 24% of nurses, 27% of other direct care staff, and 17% of nondirect care staff witnessed parent-to-child hitting at their medical center in the past year. A majority of physicians, nurses, and other direct care staff reported intervening sometimes or always. Nondirect care staff rarely intervened. Believing staff have the responsibility to intervene, and having comfortable strategies with which to intervene were strongly predictive of intervention behavior. Staff who did not intervene commonly reported that they did not know how to respond. Many medical center staff witness parent-to-child hitting. Although some of the staff reported that they intervened when they witnessed this behavior, the findings indicate that staff may need training to identify when and how they should respond.

A scabies outbreak in a diabetic and collagen disease ward: Management and prevention.

Scabies is an infection caused by Sarcoptes scabiei. In developed countries, scabies remains an important public health problem in hospitals and care facilities among elderly or immunocompromised patients. There are a number of medical providers who have not experienced scabies and there has been confusion surrounding its management and prevention. Therefore, the aim of the present study was to identify the optimal approach for the management and prevention of scabies. A scabies outbreak occurred between June 2014 and October 2014 in the Toho University School of Medicine, Omori Hospital (Tokyo, Japan), and the current study investigates factors concerning the outbreak, such as disease recognition, diagnostic strategy, medical staff experience and correspondence after the outbreak occurred. Six patients were newly diagnosed with scabies including patients, medical staff and family of the medical staff. An infection control committee was implemented and required a follow-up survey of 181 people (144 patients and 37 medical staff). It took ~4 months to resolve the outbreak. Scabies is highly infectious, and sufficient knowledge is required to care for the patients and prevent the infection of healthy people. In this example, the spread of infection was controlled by prompt action.

Patient, nursing and medical staff experiences and perceptions of the care of people with palliative esophagogastric cancer: a systematic review of the qualitative evidence.

Esophagogastric cancer is the fifth most common malignancy and its incidence is increasing. The disease progresses quickly and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence on the most effective service models to support esophagogastric cancer patients. The overall objective of this systematic review was to synthesize the best available evidence on the experiences and perceptions of patients and health professionals with regard to the care of people diagnosed with palliative esophagogastric cancer. The review considered studies that included patients diagnosed with palliative esophagogastric cancer and any health professionals involved in the delivery of palliative care to this patient group in a hospital, home or community setting. The review considered studies that investigated the experiences and perceptions of people diagnosed with palliative esophagogastric cancer and staff working with these people. Studies that were carried out in any setting, including in-patient and outpatient areas, specialist cancer and non-specialist palliative care services and those were any patient were in receipt or had experiences of palliative care services were considered. All types of health practitioners delivering palliative care to esophagogastric cancer patients were considered. Studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and narrative approaches were considered. Mixed methods studies were considered in the review only if qualitative findings were reported separately. A three-step search strategy was utilized. A total 11 databases were searched for studies from 2000 onward, followed by hand searching of reference lists. Methodological quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI). Qualitative findings were extracted using the JBI-QARI data extraction Instrument. Qualitative research findings were pooled using a pragmatic meta-aggregative approach. The review included two publications. There were 46 findings which were aggregated into four categories and one overall synthesized finding: "In addition to support for physical needs, patients need support that takes into account changing life situations to achieve the best quality of life." The review shows that patients value services and support that addresses their complex, fluctuating and highly individual needs. No evidence was uncovered regarding how these services should be designed and delivered.

Information and/or medical technology staff experience with regulations for medical information systems and medical devices

ObjectivesRegulations heavily control medical technology (MT), which often includes information technology (IT), but staff experiences related to these regulations are unknown. The study aim was to assess Swedish IT/MT staff experiences regarding regulations for medical devices and medical information systems. MethodsAn anonymous, ten-item, self-report questionnaire was administered to IT and MT staff (N=228) who attended a 3-h training course on IT and information security and MT regulations in 2014. ResultsMost of the 228 (86%) IT and MT staff who completed the survey strongly agreed that IT security and MT security are relevant to patient safety. One third of the IT staff reported feeling that their knowledge about regulations within MT was sufficient. Less than half of the respondents experienced that healthcare professionals generally had sufficient knowledge of IT or MT regulations (41% versus 46%, IT and MT regulations, respectively). ConclusionsAlthough IT/MT staff felt that they had knowledge of regulations for medical devices and medical information systems, they reported that maintaining and increasing this knowledge is important and that there is a need for recurring training programs in IT and MT regulations. Improved knowledge in IT and MT regulation, and a better understanding of clinical healthcare, could lead to an increased quality in the daily operations and support to the healthcare professionals. Healthcare professionals may need education to develop their knowledge of IT or MT regulations, which in turn will ensure higher patient safety.

Short message service (SMS) texting as a method of communication during on call: prevalence and experience of medical staff in a large acute NHS Trust in the UK

With the widespread use of smartphones, text messaging has become an accepted form of communication for both social and professional use in medicine. To our knowledge no published studies have assessed the prevalence and use of short message service (SMS) texting by doctors on call. We have used an online questionnaire to seek information from doctors in a large NHS Trust in the UK about their use of texting while on call, what they use it for, and whether they send images relevant to patients’ care. We received 302 responses (43% response rate), of whom 166 (55%) used SMS while on call. There was a significant association between SMS and age group (p=0.005), with the 20-30-year-old group using it much more than the other age groups. Doctors in the surgical specialties used it significantly less than those in other speciality groups (p<0 .001). Texting while on call was deemed to be safe and reliable (p<0.001). Eighteen clinicians (11%) admitted to routinely sending images of patients by text, despite some being identifiable. Texting was mainly used to update colleagues on patients’ progress and give information about times of ward rounds and meetings. With the increasing use of texting in healthcare, much of which seems to be unregulated, further work and detailed guidance is required on what information may be given to ensure confidentiality and that SMS is a safe and acceptable method of communication to use when on call.

Qualitative study on cancer patients agonal judge of medical staff

Objective To explore what symptoms which medical staff judged from determination of agonal symptoms in cancer patients. Methods Focus group interview was conducted by 3 groups, 5 people in each group in appropriate time and place at May 2015. The interview was conducted around theme of how to judge advanced cancer patients in . Results Agonal patients often showed changes in 7 aspects by content analyzing included pain, the last radiance of setting sun , consciousness, breathing patterns, blood circulation, intake and output volume and functional status. Besides, instinct and experience of medical staff was another determinant. Conclusions Medical staff members have their qualitative understanding on evaluating when cancer patients are agonal. Changes in some symptoms before death can provide references for evaluating survival time. Key words: Cancer patients; Agonal stage; Hospice care; Qualitative research; Symptoms of dying

How Accurate are Emergency Department Medical Staff in the Interpretation of Head Injury Related Computed Tomography?

Introduction Computed tomography (CT) brain has become a popular modality to detect head injury related problems for patients seen at the Emergency Departments (ED) in Hong Kong. This study aims to assess the diagnostic accuracy of local ED medical staff in interpretation of head injury related CT and to assess the association between years of working experience of ED medical staff and the diagnostic accuracy of CT brain interpretation. Methods This is a retrospective cohort study reviewing all patients attending the ED of Princess Margaret Hospital in three years (from 2008 to 2010) with head injuries requiring CT brain during ED stay. The findings of CT brain by ED medical staff were compared with those by radiologists, the reference standard. Results A total of 1716 cases were assessed. The overall sensitivity and specificity for detecting an abnormal CT were 0.66 (95% confidence interval [CI] 0.60-0.71) and 0.96 (95% CI 0.95-0.97), respectively. The sensitivity showed an increasing trend from 0.63 (95% CI 0.54-0.72) in ED staff with 0-3 years of working experience, to 0.71 (95% CI 0.59-0.84) with 4-6 years of experience and 0.75 (95% CI 0.63-0.86) with 7-10 years of experience. It dropped to 0.59 (95% CI 0.47-0.71) with more than 10 years of experience. Conclusions The head injury related CT interpretation skill by ED medical staff is suboptimal. More training is necessary. (Hong Kong j.emerg.med. 2015;22:241-247)

Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system.

Advance Care Planning in palliative care: A qualitative investigation into the perspective of Paediatric Intensive Care Unit staff

Background: The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. Aim: To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Design: Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. Setting/participants: UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Findings: Four main themes emerged: recognition of an illness as ‘life-limiting’; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Conclusions: Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life.

Violence and its variants in nurses: A review article

Background and Purpose: Violence is defined as unnecessary hostile behavior in clinical environments, which may lead to psychological abuse by colleagues. This systematic review aimed to evaluate violence and its associated factors among nurses. Methods: In this study, we searched for articles and patented documentations published until December 2014 via databases such as PubMed, Medline, Scopus, Google Scholar, Iranian Journal Database (Magiran), Scientific Information Database (SID), IranMedex and Iranian Biomedical Journal. Using keywords such as violence, horizontal violence, lateral violence, prevalence, predisposing factors and bullying, we found 84 articles out of 19,000 search results. Results: Violence has a variable definition in different cultures. Violent behavior in clinical environments is influenced by factors such as age, gender, work experience, work shifts, working hours and employment status of medical staff. In nurses, violence could lead to adverse outcomes, such as physical and psychological damages. Conclusion: According to the results of this study, male and younger nurses are more frequently exposed to violent behavior compared to female and elder nurses. Therefore, nurses should be informed on the adverse effects of violent behavior. In this regard, authorities and management of medical centers should show zero tolerance for violent behaviors on behalf of nursing staff.

A robust estimation model for surgery durations with temporal, operational, and surgery team effects.

For effective operating room (OR) planning, surgery duration estimation is critical. Overestimation leads to underutilization of expensive hospital resources (e.g., OR time) whereas underestimation leads to overtime and high waiting times for the patients. In this paper, we consider a particular estimation method currently in use and using additional temporal, operational, and staff-related factors provide a statistical model to adjust these estimates for higher accuracy.The results show that our method increases the accuracy of the estimates, in particular by reducing large errors. For the 8093 cases we have in our data, our model decreases the mean absolute deviation of the currently used scheduled duration (42.65 ± 0.59 minutes) by 1.98 ± 0.28 minutes. For the cases with large negative errors, however, the decrease in the mean absolute deviation is 20.35 ± 0.74 minutes (with a respective increase of 0.89 ± 0.66 minutes in large positive errors). We find that not only operational and temporal factors, but also medical staff and team experience related factors (such as number of nurses and the frequency of the medical team working together) could be used to improve the currently used estimates. Finally, we conclude that one could further improve these predictions by combining our model with other good prediction models proposed in the literature. Specifically, one could decrease the mean absolute deviation of 39.98 ± 0.58 minutes obtained via the method of Dexter et al (Anesth Analg 117(1):204-209, 2013) by 1.02 ± 0.21 minutes by combining our method with theirs.

Palliative care staff's perceptions of do not attempt cardiopulmonary resuscitation discussions.

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions aim to prevent unwanted and/or clinically inappropriate CPR attempts. As the NHS Scotland DNACPR policy has become embedded into clinical practice there has been greater awareness of the need to discuss DNACPR decisions with patients who would not benefit from CPR; however, little is known about how nursing and medical staff experience these discussions. This study aimed to explore clinician experiences of discussing DNACPR decisions with patients in a Scottish specialist palliative care inpatient and community setting. Semi-structured face-to-face interviews were held with 11 specialist palliative care clinicians. These were transcribed and thematic analysis was undertaken. The clinicians found DNACPR discussions challenging and experienced anxiety before discussions took place. They found it most appropriate to discuss DNACPR in the context of wider end-of-life discussions and in response to patient triggers. Patient-clinician relationships were complex and could make the conversation easier or more difficult. Negative patient reactions were rare and discussions were thought to provide some patients with a sense of relief. The clinicians reported finding DNACPR discussions worthwhile and that they continue to discuss DNACPR decisions with patients despite the challenges. Recommendations for discussing DNACPR with patients are outlined.

Pilot study of a new paradigm in the management of surgical emergencies using emergency surgery ambulatory care

The number of emergency admissions to hospital in the UK has been increasing for many years. The cause is multifactorial and relates to increasing population age and associated comorbidity, changes in community medical emergency cover, patient expectations and decreased clinical experience of junior medical staff. Beds occupied by emergency patients within a constrained total lead inevitably to cancellation of procedures for elective patients.