Qual Saf Health Care
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Qual Saf Health Care · Dec 2010
Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals.
Improving end-of-life care in the hospital is a national priority. ⋯ There is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical to establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.
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Cardiac surgery (PCS) has a low error tolerance, is dependent upon sophisticated organisational structures and demands high levels of cognitive and technical performance. The aim of the study was to assess the role of intraoperative non-routine events (NREs) and team performance on paediatric cardiac surgery outcomes. The current paper focuses on improving methods for studying teamwork; a companion paper will report on the empirical results. ⋯ PCS is an ideal model to explore team performance. A challenge for the future is to make observations of teamwork in healthcare settings more efficient and robust.
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Qual Saf Health Care · Dec 2010
Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members.
Clinical handover between paramedics and the trauma team is undertaken in a time-pressured environment. Paramedics are often required to handover complex problems to a multitude of staff. There is evidence that information loss occurs at this transition. The aims of this project were to (1) develop a minimum dataset to assist paramedics provide handover; (2) identify attributes of effective and ineffective handover; (3) determine the feasibility of advanced data transmission; and (4) identify how to best display data in trauma bays. ⋯ There is support for the adoption and further evaluation of a handover template. It can provide valuable structure to the face-to-face handover, and experience from other specialties suggests it can reduce information loss. Strategies to enable information to be transmitted in advance of the patients' arrival must address concerns voiced by paramedics.
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Qual Saf Health Care · Dec 2010
The impact of shift patterns on junior doctors' perceptions of fatigue, training, work/life balance and the role of social support.
The organisation of junior doctors' work hours has been radically altered following the partial implementation of the European Working Time Directive. Poorly designed shift schedules cause excessive disruption to shift workers' circadian rhythms. ⋯ The impact of junior doctors' work schedules is influenced by the nature of specific shift sequences, educational considerations, issues of work/life balance and by social support systems. Poorly designed shift rotas can have negative impacts on junior doctors' professional performance and educational training, with implications for clinical practice, patient care and the welfare of junior doctors.
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Effective handoff practices (ie, mechanisms for transferring information, responsibility and authority) are critical to ensure continuity of care and patient safety. ⋯ This study provides insights into the multidimensional concept of handoff quality. Our rating tool is feasible and comprehensive by including not only characteristics of the information process but also aspects of teamwork and, thus, provides an important tool for future research on patient handoff.