Management Of Critical Events Research Articles

Increasing the Accuracy of Extracorporeal Membrane Oxygenation Critical Event Management in the Medical Intensive Care Unit

Extracorporeal membrane oxygenation (ECMO) is an intervention that replaces cardiopulmonary function temporarily to reduce injury to vital organs. As important members of the ECMO medical team, intensive care unit nurses must be well trained and alert to possible critical events. Failure to troubleshoot and manage ECMO promptly and correctly significantly increases the risk of mortality. A previous ECMO critical event in our unit resulted in lingering concerns and stress among nurses related to implementing this intervention. A survey conducted among our medical intensive care unit (MICU) nurses identified an implementation accuracy level for ECMO critical event management of only 59.1%. This poor result was attributed to a lack of technical assessment standards, in-service training, clinical experience, and instruction materials and the failure to offer online courses. This study was designed to increase the accuracy of ECMO critical event management implementation among intensive care unit nurses to >86%. We conducted a problem-based training project to improve ECMO critical event management that: introduced a technical assessment sheet and technical simulation exercise, organized in-service training, implemented irregular simulation exercises, and produced multiple different instructional materials. The accuracy of ECMO critical event management implementation among the intensive care unit nurses increased from 59.1% pretest to 95.9% posttest. This project improved the ECMO care ability of MICU nurses in our hospital significantly, resulting in increased ECMO critical event management implementation accuracy, better patient care, higher nursing staff confidence, and lower perceived stress among nursing staff.

Advantages of IoT-Based Geotechnical Monitoring Systems Integrating Automatic Procedures for Data Acquisition and Elaboration.

Monitoring instrumentation plays a major role in the study of natural phenomena and analysis for risk prevention purposes, especially when facing the management of critical events. Within the geotechnical field, data collection has traditionally been performed with a manual approach characterized by time-expensive on-site investigations and monitoring devices activated by an operator. Due to these reasons, innovative instruments have been developed in recent years in order to provide a complete and more efficient system thanks to technological improvements. This paper aims to illustrate the advantages deriving from the application of a monitoring approach, named Internet of natural hazards, relying on the Internet of things principles applied to monitoring technologies. One of the main features of the system is the ability of automatic tools to acquire and elaborate data independently, which has led to the development of dedicated software and web-based visualization platforms for faster, more efficient and accessible data management. Additionally, automatic procedures play a key role in the implementation of early warning systems with a near-real-time approach, providing a valuable tool to the decision-makers and authorities responsible for emergency management. Moreover, the possibility of recording a large number of different parameters and physical quantities with high sampling frequency allows to perform meaningful statistical analyses and identify cause–effect relationships. A series of examples deriving from different case studies are reported in this paper in order to present the practical implications of the IoNH approach application to geotechnical monitoring.

Clinical Pearls

There are more than 1½ million hospital admissions each year attributed to sepsis, with nearly one-third of those patients dying. Although many seek outpatient care before their hospitalization, little is known about the circumstances surrounding these clinic visits.Miller and colleagues conducted retrospective chart reviews and found 10% of adult patients admitted with sepsis sought clinic care on the day of or the day before their hospital admission, and of those: With the aim to improve sepsis care, the authors recommend development of algorithms to assist outpatient providers in identifying high-risk patients who would benefit from accelerated transfer to the emergency department.See Article, pp 135–139Telemedicine is the electronic sharing of medical information between sites. This technology now includes real-time management of critical events involving patients in intensive care units (ICUs) by off-site clinicians. Although telemedicine research shows positive patient outcomes, findings on staff acceptance of this technology have been mixed.Kaplow and Zellinger examined nurses’ perceptions of telemedicine, comparing nurses who had only medical-surgical experience with nurses who had at least 5 years of critical care experience. They found The authors suggest that sharing successful telemedicine outcomes with staff as part of the system implementation process to show how the technology supplements but does not replace bedside critical thinking and interventions.See Article, pp 122–127Patients in the intensive care unit (ICU) are 5 times more likely than non-ICU patients to have hospital-acquired pressure injuries (HAPIs) develop. Although the Braden skin risk assessment scale has been widely used for years, it lacks predictive validity with critically ill patients. The Cubbin- Jackson scale was specifically developed for the ICU, yet little research has compared the 2 scales in the same set of patients.Delawder and colleagues evaluated the construct validity of the Cubbin-Jackson scale, meaning how well it assesses for HAPIs, and also compared its predictive validity with that of the Braden scale. They found Findings suggest that the Cubbin-Jackson scale may be a suitable alternative to the Braden scale for assessment of HAPIs in the adult ICU population.See Article, pp 140–144Professional quality of life is a balance between compassion fatigue, in particular burnout and secondary trauma, and compassion satisfaction. Although various professional organizations, including the American Association for Critical- Care Nurses and the National Academy of Medicine, have developed initiatives and standards for addressing compassion fatigue, burnout remains an ongoing issue.Kelly and colleagues surveyed nurses from adult intensive care units (ICUs) to examine the relationship between their perceptions of work environment and outcomes on the Professional Quality of Life instrument. They found The authors recognize burnout not as an individual phenomenon but an organizational one that can be prioritized and modified with strategies such as nurse well-being assessments, formal reward and recognition programs, and stronger support for early- career nurses.See Article, pp 113–120

Anesthesia for high-risk procedures in the catheterization laboratory.

Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus-dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic-related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

Governing Major Event Legacy: Case of the Glasgow 2014 Commonwealth Games

This article explores the emerging importance of planning and governance surrounding the concept of event legacy by focusing on an in-depth case study of the Glasgow 2014 Commonwealth Games. Given the long-term nature of the concept of legacy, the need for planned and thorough pre-, during, and post-Games management is essential if legacy outcomes are to be monitored effectively. Research method employed for this study consist of in-depth interviews (n = 14) with policy makers, organizers, and local community associations who were involved with legacy planning and implementation for the Glasgow 2014 Commonwealth Games. The findings present Glasgow's legacy approach as an advancement in the understanding of legacy governance and planning in relation to critical event management. By designing and implementing legacy governance structures at an early stage, each stakeholder role is established and can be monitored while allowing for some flexibility within the legacy management partnerships. In addition, the notion of a partnership legacy can be seen to have grown from innovative legacy governance structures, such as collaborative working and network creation, put in place by Glasgow in the early stages of legacy planning, which can act as a model of best practice for other major event host destinations.

Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists.

We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to nine ordinal scale) ratings of participant's technical and nontechnical performance. Raters also judged whether the performance was at a level expected of a board-certified anesthesiologist. Rater reliability for most measures was good. In 284 simulated emergencies, participants were rated as successfully completing 81% (interquartile range, 75 to 90%) of the critical performance elements. The median rating of both technical and nontechnical holistic performance was five, distributed across the nine-point scale. Approximately one-quarter of participants received low holistic ratings (i.e., three or less). Higher-rated performances were associated with younger age but not with previous simulation experience or other individual characteristics. Calling for help was associated with better individual and team performance. Standardized simulation-based assessment identified performance gaps informing opportunities for improvement. If a substantial proportion of experienced anesthesiologists struggle with managing medical emergencies, continuing medical education activities should be reevaluated.

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies

Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase).

Listas de chequeo de la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) para el manejo de eventos críticos en salas de cirugía: traducción y actualización basada en la evidencia

IntroductionIntraoperative critical events are rare situations and their management in some occasions may be inaccurate or not done in time. ObjectiveTo translate and update checklists for the management of critical events in the operating room developed by Adriadne Labs, based on secondary clinical evidence. Materials and methodsFor the translation and update of checklists, we followed the recommendations of Adriadne Labs for the modification of the checklists according to a systematic methodology divided in steps: 1)translation of the original checklists; 2)systematic research of the literature; 3)evaluation and selection of the evidence; 4)adaptation of the checklist for the management of local anesthetic toxicity; 5)changes, subtractions, and additions to the translated lists, and 6)diagramming of the checklists. ResultsWe translated to Spanish the 12 original checklists and adapted a new checklist for the management of local anesthetic systemic toxicity. As a result of the systematic research of the literature, we retrieved 1.407 references and selected 7 papers that were used to update the new checklists based on evidence. The new checklists were diagrammed according to the recommendations of design of the original lists. ConclusionTwelve checklists were translated and updated and a new one for the management of local anesthetic systemic toxicity was adapted based on a systematic review of the literature.

Checklists of The Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.) for managing critical events in the OR: Translation and evidence-based update

IntroductionCritical intraoperative events are rare and may sometimes be managed poorly and too late. ObjectiveTo translate and update the checklists developed by Ariadne Labs for management of critical events in the OR and to adapt the list for managing anesthetic toxicity, based on secondary clinical evidence. Materials and methodsIn order to translate and update the checklists, the recommendations given by Ariadne Labs were followed to change the original checklists in accordance with a systematic methodology that comprises three phases: (1) translation of the original lists, (2) systematic literature search, (3) evaluation and selection of evidence, (4) adaptation of the list for managing anesthetic toxicity, (5) changes, deletions, and additions to the translated lists, and (6) layout of the checklists. ResultsThe 12 original checklists were translated into Spanish and a new list was adapted for managing toxicity from local anesthetic agents. As a result of the systematic literature search, 1407 references were screened, from which 7 articles were selected and included for evidence-based updating of the new checklists. The layout of the new lists was consistent with the design recommendations of the original lists. Conclusion12 translated and updated checklists were submitted and a new list was adapted for the management of local anesthetics toxicity, based on a systematic literature review.

Evaluation of a Simpler Tool to Assess Nontechnical Skills During Simulated Critical Events.

Management of critical events requires teams to employ nontechnical skills (NTS), such as teamwork, communication, decision making, and vigilance. We sought to estimate the reliability and provide evidence for the validity of the ratings gathered using a new tool for assessing the NTS of anesthesia providers, the behaviorally anchored rating scale (BARS), and compare its scores with those of an established NTS tool, the Anaesthetists' Nontechnical Skills (ANTS) scale. Six previously trained raters (4 novices and 2 experts) reviewed and scored 18 recorded simulated pediatric crisis management scenarios using a modified ANTS and a BARS tool. Pearson correlation coefficients were calculated separately for the novice and expert raters, by scenario, and overall. The intrarater reliability of the ANTS total score was 0.73 (expert, 0.57; novice, 0.84); for the BARS tool, it was 0.80 (expert, 0.79; novice, 0.81). The average interrater reliability of BARS scores (0.58) was better than ANTS scores (0.37), and the interrater reliabilities of scores from novices (0.69 BARS and 0.52 ANTS) were better than those obtained from experts (0.47 BARS and 0.21 ANTS) for both scoring instruments. The Pearson correlation between the ANTS and BARS total scores was 0.74. Overall, reliability estimates were better for the BARS scores than the ANTS scores. For both measures, the intrarater and interrater reliability was better for novices compared with domain experts, suggesting that properly trained novices can reliably assess the NTS of anesthesia providers managing a simulated critical event. There was substantial correlation between the 2 scoring instruments, suggesting that the tools measured similar constructs. The BARS tool can be an alternative to the ANTS scale for the formative assessment of NTS of anesthesia providers.

The Development and Implementation of Cognitive Aids for Critical Events in Pediatric Anesthesia: The Society for Pediatric Anesthesia Critical Events Checklists

Cognitive aids such as checklists are commonly used in modern operating rooms for routine processes, and the use of such aids may be even more important during critical events. The Quality and Safety Committee of the Society for Pediatric Anesthesia (SPA) has developed a set of critical-event checklists and cognitive aids designed for 3 purposes: (1) as a repository of the latest evidence-based and expert opinion-based information to guide response and management of critical events, (2) as a source of just-in-time information during critical events, and (3) as a method to facilitate a shared understanding of required actions among team members during a critical event. Committee members, who represented children's hospitals from across the nation, used the recent literature and established guidelines (where available) and incorporated the expertise of colleagues at their institutions to develop these checklists, which included relevant factors to consider and steps to take in response to critical events. Human factors principles were incorporated to enhance checklist usability, facilitate error-free accomplishment, and ensure a common approach to checklist layout, formatting, structure, and design.The checklists were made available in multiple formats: a PDF version for easy printing, a mobile application, and at some institutions, a Web-based application using the anesthesia information management system. After the checklists were created, training commenced, and plans for validation were begun. User training is essential for successful implementation and should ideally include explanation of the organization of the checklists; familiarization of users with the layout, structure, and formatting of the checklists; coaching in how to use the checklists in a team environment; reviewing of the items; and simulation of checklist use. Because of the rare and unpredictable nature of critical events, clinical trials that use crisis checklists are difficult to conduct; however, recent and future simulation studies with adult checklists provide a promising avenue for future validation of the SPA checklists. This article will review the developmental steps in producing the SPA crisis checklists, including creation of content, incorporation of human factors elements, and validation in simulation. Critical-events checklists have the potential to improve patient care during emergency events, and it is hoped that incorporating the elements presented in this article will aid in successful implementation of these essential cognitive aids.

ASCIA‐P31: PRACTICE MAKES PERFECT: THE USE OF SIMULATION IN ANAPHYLAXIS TREATMENT TO IMPROVE CLINICAL SKILLS THAT CAN LEAD TO IMPROVED PATIENT OUTCOMES

Anaphylaxis is a life-threatening, allergic emergency needing prompt, appropriate treatment. Nurses working in hospitals receive regular anaphylaxis management training. However, nurses working in non-acute environments, such as private or general practices, only receive update training at the employer's or nurse's own discretion. Simulation has been successfully used for updating anaphylaxis skills in nursing and medicine (Oleary et al. 2013; Mason & Lyons 2013) and ambulance staff (Lamers et al. 2014) enabling staff reflection. Such opportunities are rare for staff working outside acute environments. A pilot simulation exercise was held in a university nursing school practice-based simulation laboratory, during an Australian Allergy Nursing conference, to highlight gaps in nurses’ knowledge, improve their clinical experience and critical event management of anaphylaxis. Evaluation was undertaken by a pre-and post-event questionnaire. Twelve participants participated two 20 minute anaphylaxis simulations. Scenario 1 involved recognition and treatment of a 6 year old child who developed anaphylaxis to peanut in a community-based setting. The second involved recognition and treatment of a 55 year old female who experienced anaphylaxis in a hospital allergy clinic while undergoing bee-venom immunotherapy. Specialist Allergy Nurses facilitated the filmed simulation exercise. For 30 minutes prior to the simulation, participants also practiced with equipment discussing emergency situation, communication and decision making activities related to anaphylaxis. Debriefing and re-playing of the simulation recordings assisted participants to reflect on their participation, actions and learning. Nurses valued the opportunity to participate in the simulation environment. Common to both scenarios were team-work errors, delays in communicating, documenting and administering adrenalin. Nurses found the exercise identified and improved their skills in anaphylaxis management in a non-threatening environment and suggested it be incorporated in allergy programs annually.

A whole-of-business approach to major accident event preparedness

Recent disasters such as Montara and Macondo have highlighted the devastating impact that major accident events (MAE) have on organisations. This awareness is reflected within industry, among regulators and by professional organisations, who are all increasing their focus on process safety management to prevent MAEs. This extended abstract posits that the increased focus on process safety management, while essential as a preventative measure, provides only part of the broader solution that underpins a robust business resilience framework. Such a framework delivers a systematic whole-of-business approach to MAE prevention, preparedness, response and recovery, and highlights the role corporate strategy and governance play in better managing and preparing all levels of an organisation for a MAE. The authors ask the following questions: To what extent are organisations really prepared to manage the consequences of a MAE? Are organisations investing appropriately to support MAE preparedness across all levels of their business? In this context, this extended abstract discusses the significance of a robust business resilience framework that incorporates and understands the interdependencies of enterprise risk management, business continuity planning, critical event management, and the lessons that have been learned. It identifies the importance of the role of executives and senior leaders in a robust framework, and the value of continued investment in a complete whole-of-business MAE solution. The authors outline a framework for implementation at all business levels that will build overall business resilience to prepare for a MAE.

Intraoperative crisis resource management during a non-intubated video-assisted thoracoscopic surgery.

The management of surgical and medical intraoperative emergencies are included in the group of high acuity (high potential severity of an event and the patient impact) and low opportunity (the frequency in which the team is required to manage the event). This combination places the patient into a situation where medical errors could happen more frequently. Although medical error are ubiquitous and inevitable we should try to establish the necessary knowledge, skills and attitudes needed for effective team performance and to guide the development of a critical event. This strategy would probably reduce the incidence of error and improve decision-making. The way to apply it comes from the application of the management of critical events in the airline industry. Its use in a surgical environment is through the crisis resource management (CRM) principles. The CRM tries to develop all the non-technical skills necessary in a critical situation, but not only that, also includes all the tools needed to prevent them. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific surgery such as the non-intubated video-assisted thoracoscopic surgery.

Board #214 - Program Innovation The Use of Trigger Films to Improve the Differential Diagnosis and Management of Critical Events in the Operating Room (Submission #11612)

Objectives Critical events (such as hemorrhage, bronchospasm, and ventricular fibrillation) that occur in the operating room or in critical care environments are the subjects of most anesthesia and critical care simulation scenarios. Because of the time constraints and available personnel, it is not feasible for every learner or practitioner to experience the event in a simulated environment. In addition, there is literature that identifies deficiencies in recognition and management of rare critical events.1 For example, large amounts of time can pass without a practitioner experiencing a critical event. However, if and when a critical event was to occur, the learner or clinician is expected to act decisively and appropriately. Viewing and analyzing trigger films can provide the visual and auditory education that today’s learners expect in a format that allows them to experience several critical events in a timely manner. These films have the potential to help students and practitioners become increasingly familiar with critical events that they may not experience until it occurs during patient care. Description Trigger films are short video clips (30 seconds to two minutes) that portray situations a learner or clinician may experience. Our focus is to demonstrate how these films can help with the identification and management of critical events. We will begin with films that show limited clinical data compelling the learner to assess several different causes of the crisis, which can then be discussed. Each trigger film builds on the previous one providing more clinical data until a diagnosis can be made. This model promotes active learning and encourages in-depth evaluation and discussion about the holistic view of a critical event. Then once the diagnosis has been determined, both effective and non-effective management options for the crisis can be viewed allowing the learner to see the differences in management options, and thus potentially improve their knowledge. The use of this active learning technique differs from existing teaching strategies because these films are interactive, can be presented in any location in a limited time frame, and requires only one instructor. There is evidence that demonstrates how students can improve their identification and management of anesthetic crises after they have participated in trigger film education.2 Conclusion Trigger films that focus on critical events and professional issues in the clinical area have several future applications. One such application could be future research. This research could evaluate how both learners and clinicians perform during a critical event in a simulated environment. Trigger films could also be used during critical care simulations to introduce a scenario, as well as demonstrate effective and less effective ways of managing different crisis situations. These films could be integrated into an educational curriculum. An example of how they could be used clinically would be to demonstrate an interscalene block. The film could start by demonstrating the appropriate anatomy, needle placement, and ultrasound technique. Then another film could focus on the identification and treatment of local anesthetic toxicity. Finally, these films could be the stimulus to create gaming simulations where the learner becomes a part of the simulation scenario. For an example of the films we have please visit this website: http://vimeo.com/channels/kpsanfilms.

Using a situational awareness global assessment technique for interprofessional obstetrical team training with high fidelity simulation

Evidence suggests that breakdowns in communication and a lack of situation awareness contribute to poor performance of medical teams. In this pilot study, three interprofessional obstetrical teams determined the feasibility of using the situation awareness global assessment technique (SAGAT) during simulated critical event management of three obstetrical scenarios. After each scenario, teams were asked to complete questionnaires assessing their opinion of how their performance was affected by the introduction of questions during a SAGAT stop. Fifteen obstetrical professionals took part in the study and completed the three scenarios in teams consisting of five members. At nine questions per stop, more participants agreed or strongly agreed that there were too many questions per stop (57.1%) than when we asked six questions per stop (13%) and three questions per stop (0%). A number of interprofessional differences in response to this interprofessional experience were noted. A team SAGAT score was determined by calculating the proportion of correct responses for each individual. Higher scores were associated with better adherence to outcome times, although not statistically significant. A robust study design building on our pilot data is needed to probe the differing interprofessional perceptions of SAGAT and the potential association between its scores and clinical outcome times.

Overcoming Challenges in the Management of Critical Events During Cardiopulmonary Bypass

Critical events during cardiopulmonary bypass (CPB) can challenge the most experienced perfusionists, anesthesiologists, and surgeons and can potentially lead to devastating outcomes. Much of the challenge of troubleshooting these events requires a key understanding of these situations and a well-defined strategy for early recognition and treatment. Adverse situations may be anticipated prior to going on CPB. Atherosclerosis is pervasive, and a high plaque burden may have implications in surgical technique modification and planning of CPB. Hematologic abnormalities such as cold agglutinins, antithrombin III deficiency, and hemoglobin S have been discussed with emphasis on managing complications arising from their altered pathophysiology. Jehovah's witness patients require appropriate techniques for cell salvage to minimize blood loss. During initiation of CPB, devastating situations leading to acute hypoperfusion and multiorgan failure may be encountered in patients undergoing surgery for aortic dissection. Massive air emboli during CPB, though rare, necessitate an urgent diagnosis to detect the source and prompt management to contain catastrophic outcomes. Gaseous microemboli remain ubiquitous and continue to be a major concern for neurocognitive impairment despite our best efforts to improve techniques and refine the CPB circuit. During maintenance of CPB, adverse events reflect inability to provide optimal perfusion and can be ascribed to CPB machine malfunction or physiological aberrations. We also discuss critical events that can occur during perfusion and the need to monitor for organ perfusion in altered physiologic states emanating from hemodilution, hypothermia, and acid-base alterations.

A New Algorithm for the Management of Critical Events in the Theatre

Patients may be subject to risk during surgery as a result of nontechnical as well as technical error. Effective surgical teams have been shown to have fewer problems per operation, higher intra-operative performance and shorter operating times. There is increasing evidence that interventions that improve teamwork, leadership, decision making, communication and situational awareness within operating teams also improve technical performance and patient outcome. In addition, briefings and debriefings before and at the end of operating lists have been shown to improve teamwork and communication, thereby improving patient safety.

Emergencies in children’s and young people’s nursingEmergencies in children’s and young people’s nursing Edward Alan Glasper , GillianMcEwing andJimRichardson (Eds) Oxford University Press£21.95456pp9780199547197019954719X

THIS IS an excellent book for anyone dealing with children and young adults in an emergency care environment. its subjects range from the principles of care and the management of critical events, to more common injuries and illnesses.

Gender differences in giving blood: a review of the literature.

An overview of European blood donors shows that the distribution of men and women donors is similar in many countries, with Italy being an exception in that women account for only 30% of donors. Gender medicine is a key issue in this context, even though gender studies are very limited in the transfusion field, whether considered broadly or with specific regards to the selection, management and retention of donors. It, therefore, seemed important to compare the presence of women among blood donors in different European countries and examine the roles that gender is reported to play in the donation of blood in order to identify possible implications for communication with and management of the donor. To determine the proportion of women among donors in European countries, data were collected from annual reports or documents available on the websites of national associations; furthermore, all papers related to giving blood published in the five main journals in the sector (Transfusion, Vox Sanguinis, Transfusion and Apheresis Science, Transfusion Medicine, Blood Transfusion) were considered; about 80 publications were selected and the gender variable was examined. The published studies showed that gender plays key roles in the motivation to give blood (women being more altruistic, men being more individualistic) and in adverse reactions, which was a particularly critical problem leading to fewer women become regular donors. A few aspects specific to the management of donors in Italy also emerged. Gender seems to play an important role in the aspects studied and does, therefore, merit further consideration in relation to strategies to recruit donors and the management of critical events during donation.