Multidisciplinary Team Training Research Articles

A Survey of Obstetric Anaesthesia Services and Practices in the United Kingdom.

Background Variability in obstetric anaesthetia practice and care delivered within the UK is under-explored. The ObsQoR study explored structures, processes, and outcomes of obstetric anaesthesia in 107 hospitals within the UK's National Health Service, and the results of the hospital-level survey are reported here. Methods Hospitals were surveyed to assess obstetric anaesthesia provision, practice, and care delivery. Questions explored staffing, service provision and training, facilities present, clinical practices, outcome measurement, and key indicators of quality in obstetric anaesthesia. Results We received responses from 106 participating hospitals, representing 69% of all UK obstetric units. One hundred (94%) hospitals had a dedicated consultant obstetric anaesthetist within working hours, with 27 (25%) of hospitals' duty anaesthetists having additional clinical responsibilities outside the care of obstetric patients outside of working hours. Around 102 hospitals (98%) offer multidisciplinary team training, of which 95 (93%) use a simulation-based method. Dedicated high-risk antenatal clinics were present in 50 (47%) hospitals. The majority of hospitals provide written patient information in multiple languages for discussing obstetric anaesthesia options (77, 82%). Seventy-three hospitals (69%) use point-of-care testing to estimate haemoglobin concentration. Labour epidural analgesia is most commonly delivered via patient-controlled epidural analgesia in 80 (76%) hospitals, and the incidence of post-dural puncture headaches was recorded by 80 (76%) hospitals. Conclusions These results demonstrate variation in the provision of staffing, facilities, clinical practices, and outcome measurements across the UK. To deliver safe and equitable care across the UK, there needs to be standardisation of anaesthetic peripartum care based on national recommendations and the benchmarking and measurement of appropriate markers of quality.

Multidisciplinary team training in postpartum hemorrhage: impact on the use of blood products.

Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

FP5.4 - Improving Assessment of General Surgical Trainees in Multidisciplinary Team Working as a Capability in Practice: Perceptions of General Surgical Trainees and Trainers

Abstract Aim To explore how Higher Surgical Trainees (HST) and Trainers feel multidisciplinary team (MDT) working as a capability in practice (CiP) can be improved. Methods Within a deanery, 8 General Surgical HST and 4 Consultants were recruited to participate in virtual semi-structured interviews. Once transcribed, reflexive thematic analysis was performed. Ethical approval was granted. Results MDT is not worked into most trainees’ rotas. Participants felt that by formalising MDT, as with other CiP, it could be better assessed. Trainers, half of whom are MDT leads, stated that responsibility for MDT training and assessment should be placed on all consultants, rather than solely the leads. Participants explored how pathways could be instituted for HST to maintain ‘ownership’ of some patients from assessment clinic to MDT meetings to fully engage. In order to build to this level, a baseline of preparing patients but not presenting was suggested by one of the consultants. While, with one exception, no participants favoured a further work-based assessment, it was advocated by all that further clarification from ISCP regarding expectations of trainees at MDT would allow for more comprehensive assessment in the future. Most participants proposed that all members of MDT contributed to an assessment rather than relying on the Multi-Consultant Report. To prevent issues with timing or resources, a shadow or simulated MDT was suggested for HST. Conclusion General HST and consultants expressed concerns with the current way in which MDT is assessed as a CiP however they proposed ways in which it could be improved in the future.

Blood pressure control in Türkiye: A primary healthcare pilot study

Hypertension is present in almost a third of Türkiye’s adult population. The Ministry of Health of the Republic of Türkiye in conjunction with the World Health Organization, rolled out a pilot primary health care model from February 2019 to 2020 to improve hypertension screening, management, and follow-up across the provinces of Erzincan, Çankırı and Uşak. The model was conducted in selected family health centers for one year and included multiple interventions – training of multidisciplinary primary care teams, implementation of evidence-based, standardised clinical guidelines related to monitoring and treatment of hypertension, clinical supervision and performance monitoring, and provision of health education to hypertensive individuals. Repeat surveys of population-based random samples of 975 patients were taken before (December 2018) and after (February 2020) model implementation to evaluate its effect on care delivery. There was an almost 6.5-fold increase in the measurement and subsequent recording of blood pressure compared to before model implementation (from 50 to 323). Blood pressure control improved to 58 % of measured individuals compared to 46 % of those measured at initial evaluation. The frequency of measuring risk factors and outcomes related to hypertension at least once a year increased for creatinine from 71 % to 79 %, fasting blood glucose from 70 % to 78 %, and tobacco use from 22 % to 31 %. Prescription of antihypertensive drugs increased from 49 % to 61 %. With improvements in hypertension-related care in all measures and across all regions, this primary healthcare model represents a potential paradigm for nationwide implementation.

The awareness of enhanced recovery after surgery (ERAS) cesarean delivery guidelines among anesthesiology and reanimation assistants in Turkey; a questionnaire study

BackgroundTo reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS.MethodsThis descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations.ResultsOf the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants’ institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%.ConclusionAwareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities.

GERIATRIC ASPECTS OF THE ORGANIZATION OF MEDICAL-SOCIAL, PALLIATIVE AND HOSPICE CARE IN THE CONDITIONS OF THE WAR: COMBINATION OF MEDICAL, PSYCHOLOGICAL AND SOCIAL PROBLEMS

The aim of the study is to characterize, from the point of view of geriatric aspects, the current problems of the organization of medico-social, palliative and hospice care (PHC) and social services for palliative care in the war conditions based on multidisciplinary, interagency and inter-sectoral approaches, as well as a combination of medical, psychological and social problems. Materials and methods. The research materials were scientific literary sources and regulatory documents. A pilot survey of 200 people was conducted to study the psychological state and psychological support needs of the elderly and internally displaced persons (IDPs). The survey results of 3,705 client’s questionnaires of the “Vseturbota” Project were also evaluated, of which 63.6 % are people aged 67-84 years, 26.4 % are 85–101 years old. The following research methods were used in the work: bibliosemantic, sociological, system approach and system analysis. Results and discussion. After February 24, 2022, IDPs will experience significant difficulties, suffer from reduced income, increased dependence on humanitarian aid, do not feel safe and protected. All these are reflected in their psychological state. It was found that among respondents aged ≥75 years had the most people with medium (57.1 %) and low (25.0 %) levels of anxiety, 71.4 % had a low level of mood. 32.17 % of the “Vseturbota” Project clients needed additional consultation with a family doctor, 3.83 % needed consultation with a psychologist, and 3.35 % with other specialists. Most often, they needed help around the house (26.02 %), buying medicines/foodstuff (22.43 %), 34.97 % needed information, and 13.36 % needed psychological counseling. An important condition for providing geriatric patients, including IDPs, with affordable, high-quality and effective PHC is the creation of a system and service of ambulatory/mobile and inpatient PHC facilities and medico-social care. Conclusions. The military aggression of the Russian Federation caused considerable suffering to the population of Ukraine. The state of anxiety and fear has a negative impact not only on the psycho-emotional, but also on the physical sphere of the elderly, which necessitates the implementation of psychological services and effective strategies for overcoming stress and distress, which requires the development and implementation of mechanisms for interagency coordination and cooperation, involving and training of multidisciplinary teams’ specialists and volunteers, effective advocacy activities, etc.

6292830 Multidisciplinary team training is not just simulation … Anaesthetic trainee knowledge and understanding of Cardiotocography (CTG)

6292830 Multidisciplinary team training is not just simulation … Anaesthetic trainee knowledge and understanding of Cardiotocography (CTG)

Patients with palliative needs in a tertiary hospital emergency department in 2021 - retrospective chart review

Introduction: Children with complex chronic diseases and life-limiting conditions require a differentiated and adapted medical approach. OBJECTIVES: Characterise the affluence and management of children, followed by an in-hospital pediatric palliative care support team, who presented to a tertiary hospital pediatric emergency department in 2021. Methods: A one-year retrospective analysis of emergency episodes was performed by consulting medical records. Episodes were categorized, data were recorded anonymously, and descriptive statistical analysis was carried out. Results: Of the 58 pediatric patients monitored by the team, 66% resorted to the emergency department in 2021, leading to 85 admissions (average: two per patient; 82% classified as urgent, very urgent, or immediate). The most frequent admission reasons were respiratory symptoms. Hospitalization was required in 45%: 3 patients transferred from another hospital in the pediatric intensive care unit, 32 to the pediatric ward, and the remaining in the observation service. Blood tests, cultures and imaging tests were performed in 45%, 48% and 46% respectively, and antibiotics instituted in 44%. Twenty-three children (61%) admitted to the emergency department had an orally discussed advanced care plan. No patients died in the emergency department or the intensive care unit. One died at home with support from the team and three in the ward. Discussion: The reduced emergency department visits per patient and the frequent hospitalization needed when recurring reflects the effectiveness of a differentiated multidisciplinary team, domiciliary care and caregiver training. Establishing an advanced care plan and an emergency approach protocol is fundamental for individualized care delivery.

Feasibility and acceptability of multidisciplinary team training in health coaching: Case study in adolescent rheumatology

The central importance of the biopsychosocial model of chronic disease is increasingly recognised in the management of long-term conditions (LTC), which are often associated with chronic pain, fatigue and disability. Despite the physical and mental health impact, 'struggle' to maintain self-efficacy, gap in effective transition to adult pathways and long term consequences of poor disease control and lifestyle choices in young people with LTCs, innovation in this age range is rarely reported in generic journals. This paper explores the feasibility and acceptability of health coaching with young service users to increase engagement and self-management, achieved through multidisciplinary team (MDT) training in Adolescent Rheumatology.

Model of multidisciplinary teamwork in hip fracture care: a qualitative interview study

ObjectivesHip fractures are common injuries in older age with high mortality requiring multidisciplinary clinical care. Despite guidance, there is considerable variation in hip fracture services and patient outcomes; furthermore, little...

Training interprofessional teams in geriatric emergency medicine: A modified team-based learning approach

BackgroundOlder adults deserve special healthcare provision in every branch of medicine. Turkey currently does not have geriatric emergency medicine (GEM) subspecialty training. Thus, interprofessional training for healthcare professionals involved in GEM services is required. Team-based learning (TBL) seems suitable to implement such training. We aimed to develop and implement a training program for healthcare professionals engaged with GEM services, and evaluate the program considering teacher and learner satisfaction and knowledge retention. MethodsThis was a design-based study in which a one-day GEM training program was developed based on the literature and expert opinions. The program was applied to 54 physicians, 98 nurses, 70 health officers, and 102 paramedics using a modified version of TBL. Teams included at least one representative from each profession. TBL was modified by adding a 1-h lecture and eliminating peer evaluation. Feedback forms, individual and group tests of TBL, and a retention test conducted six months later were used for program evaluation. ResultsThe mean group test score was higher than that of individual tests in all professions. Physicians’ individual test scores were higher than those of other professions, but this difference disappeared in the group test. The retention test mean score was higher than the individual test mean score but lower than that of the group test. Teacher and learner satisfaction was high. ConclusionWe implemented a training program using a modified TBL approach to teach GEM to relevant healthcare professionals; it yielded promising results regarding knowledge gain and retention, as well as teacher and learner satisfaction. The instruction design and method used in this study can be applied to multidisciplinary team training.

Gender mainstreaming in sweetpotato breeding in Uganda: a case study.

In Uganda, sweetpotato [Ipomoea batatas (L.) Lam] is typically a "woman's crop," grown, processed, stored and also mainly consumed by smallholder farmers for food and income. Farmers value sweetpotato for its early maturity, resilience to stresses, and minimal input requirements. However, productivity remains low despite the effort of breeding programs to introduce new varieties. Low uptake of new varieties is partly attributed to previous focus by breeders on agronomic traits and much less on quality traits and the diverse preferences of men and women in sweetpotato value chains. To address this gap, breeders, food scientists, and social scientists (including gender specialists) systematically mainstreamed gender into the breeding program. This multidisciplinary approach, grounded in examining gender roles and their relationship with varietal and trait preferences, integrated important traits into product profiles. Building on earlier efforts of participatory plant breeding and participatory varietal selection, new interventions showed subtle but important gender differences in preferences. For instance, in a study for the RTBFoods project, women prioritized mealiness, sweetness, firmness and non-fibrous boiled roots. These were further subjected to a rigorous gender analysis using the G+ product profile query tool. The breeding pipelines then incorporated these gender-responsive priority quality traits, prompting the development of standard operating procedures to phenotype these traits. Following an all-inclusive approach coupled with training of multidisciplinary teams involving food scientists, breeders, biochemists, gender specialists and social scientists, integration into participatory variety selection in Uganda enabled accentuation of women and men's trait preferences, contributing to clearer breeding targets. The research has positioned sweetpotato breeding to better respond to the varying needs and preferences of the users.

Abstract 13691: New Model for Prevention and Management of Venous Thromboembolism After Heart Valve Surgery

Introduction: Venous thromboembolism (VTE) is one of the possible complications that can occur after heart valve surgery. Exploring effective VTE prevention and management models for post-cardiac surgery is an important issue in perioperative management. Hypothesis: We hypothesized that a new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery. Methods: A total of 1200 patients who underwent heart valve surgery were included in this study and randomized in a 1:1 ratio into the control group and new management group. The control group received basic VTE prevention measures, while the intervention group implemented a newly designed VTE prevention and management protocol in addition to the basic preventive measures. The protocol included multidisciplinary team training and assessment, a comprehensive VTE evaluation mechanism, proper execution of preventive measures, physical and mechanical prophylaxis, patient rehabilitation training, and education. The primary outcome measure was the incidence of perioperative VTE, and secondary outcome measures included the occurrence of postoperative pulmonary embolism and all-cause mortality after heart valve surgery. Results: The intervention group included a total of 600 patients, with 57.6% being male and an average age of 56.7 ± 13.4 years. The control group also included 600 patients, with 55.5% being male and an average age of 57.5 ± 12.8 years. There were no significant differences in general clinical data between the two groups. The incidence of in-hospital deep vein thrombosis (DVT) in the intervention group was significantly lower than that in the control group (0.3% vs 1.5%, P<0.05). However, there were no significant differences between the two groups in terms of in-hospital pulmonary embolism and early postoperative all-cause mortality. The intervention group showed a significantly higher accuracy rate in VTE risk assessment compared to the control group (91.3% vs 87.9%, P<0.05). Conclusions: The new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery, providing important evidence for the prevention and management of VTE in cardiac surgery.

Anaesthaesia for Category-1 urgency Ceasarean section

Caesarean section is the most performed surgical intervention worldwide. A proportion of these caesarean deliveries will necessitate emergency care for maternal and fetal compromise. Anaes-thetic management in these situations can be challenging and a short decision to delivery interval is burning. Current evidence suggests that multidisciplinary communication is essential to support anaesthetic management and optimise team performance. Communication should be supported by using a standardised classification of urgency tool. The four-grade classification scale has increasingly been adopted internationally. While neuraxial techniques are favoured for caesarean sections, gen-eral anaesthesia has an essential role in category 1 caesarean section (defined as a caesarean section in which there is an immediate threat to life for the mother or fetus). The risks and benefits of general and neuraxial anaesthesia for the woman and her baby must be carefully weighed on an individual base. Beyond the delivery of anaesthesia, other practical strategies, such as multidiscipli-nary team training, can contribute to improved maternal and neonatal outcomes.

Simple steps towards improving safety in obstetric airway management: A quality improvement project.

Guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society state that 'a videolaryngoscope should be immediately available for all obstetric general anaesthetics'. To report the incidence of videolaryngoscopy use, and other airway management safety interventions, in an obstetric population before and after various quality improvement interventions. Prospective data collection was undertaken over 18 months, divided into three separate 6-month periods: June to November 2019; March to August 2021; January to June 2022. These periods relate to evaluation of specific quality improvement interventions. The project was carried out in a large tertiary referral obstetric unit. We identified 401 pregnant women (> 20 weeks' gestation) and postnatal women (up to 48 h post delivery) undergoing an obstetric surgical procedure under general anaesthesia. To standardise practice, an intubation checklist was introduced in December 2020 and multidisciplinary staff training in August 2021. Primary outcome measures were use of a Macintosh-style videolaryngoscope and tracheal intubation success. Secondary outcome measures were use of an intubation checklist; low flow nasal oxygen; and ramped patient positioning. Data from 334 tracheal intubations (83.3% of cases) were recorded. Videolaryngoscope use increased from 60% in 2019, to 88% in 2021, to 94% in 2022. Tracheal intubation was successful in all patients, with 94% first pass success overall and only 0.9% requiring three attempts. Use of secondary outcome measures also increased: low flow nasal oxygen from 48% in 2019 to 90% in 2022; ramped positioning from 95% in 2021 to 97% in 2022; and checklist use from 63% in 2021 to 92% in 2022. We describe the successful adoption of simple safety measures introduced into routine practice. These comprised videolaryngoscopy, ramped positioning and low flow nasal oxygen. Their introduction was supported by the implementation of an intubation checklist and multidisciplinary team training.

Quality improvement collaborative to optimize heart failure care inpatients from a network ofclinics inArgentina during the COVID-19 pandemic.

Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.

Enhancing Obstetric Care During Emergencies Through Multidisciplinary Team Training

Enhancing Obstetric Care During Emergencies Through Multidisciplinary Team Training

The Role of Educational Nurses in Inpatient Management for Diabetes Care: 2023 ADA Practice Guidelines

Diabetes management for inpatients is difficult for many hospitals and education experts. Hospital medical staff tends to rely only on a “sliding scale” of insulin to address high glucose level and often overlook hyperglycemia. In order to support hospitalized people with diabetes and hyperglycemia, diabetes management and education experts must be employed. In addition, there are movements calling for development of an inpatient blood sugar management department. Diabetes education should target not only education of patients, family, and caregivers regarding care of inpatients, but also multidisciplinary team training and diabetes-related organizational quality indicators and results.

Establishing communities of practice to improve health policy, systems and reproductive, maternal, newborn, child and adolescent health in West Africa.

To explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts. A case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions. The Economic Community of West African States (ECOWAS). Professionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries. Training and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams. The desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints. This study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact. None declared.

Interdisciplinary Team Work in the Training of Doctors of Perinatal Centers and Maternity Hospitals in Perm Region

The paper presents the experience of conducting a professional development cycle for doctors of perinatal centers and maternity hospitals in the Perm region with specialized trainings and multidisciplinary team training in a simulation center. Conducting problematic trainings for multidisciplinary medical teams in typical emergency situations contributes to good survival of emergency skills and compliance with quality criteria for medical care in emergency conditions.