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British Journal of Nursing (Mark Allen...to understand the purpose, impact and experience of nurse handover from patient and staff perspectives. (Observational Study)
Observational Study
AIM AND OBJECTIVES
to understand the purpose, impact and experience of nurse handover from patient and staff perspectives.
BACKGROUND
poor communication is increasingly recognised as a major factor in healthcare errors. Handover is a key risk point. Little consensus exists regarding the practice in nursing but the trend is towards bedside handover. Research on patient and staff experiences of handover is limited.
DESIGN
a qualitative and observational study on two acute wards in a large urban hospital in the UK.
METHODS
interviews conducted with patients and staff and observation of handovers, ward rounds and patient-staff interactions.
RESULTS
diverse forms of nurse handover were found, used in combination: office based (whole nursing team), nurse in charge (NIC) to NIC, and bedside. Patients' and nurses' views concurred on the purpose of bedside handover--transference of information about the patient between two nurses--and about the medical ward round, which was seen as a discussion with the patient. Views diverged regarding the purpose and value of office handover. Bedside handover differed in style, content, and place of delivery, often driven by concerns regarding confidentiality and talking over patients, and there were varied views on the benefits of patient involvement in bedside handover. Nurses worked beyond their shift end to complete handover. Communication problems within the clinical team were identified by staff and patients.
CONCLUSIONS
while it is important to agree the purpose of handover and develop appropriate structure, content and style, it need not be a uniform process in all clinical areas. Nurse training to deliver bedside handover and patient information on the purpose of handover and the patient's role would be beneficial.
Topics: Communication; Humans; Interviews as Topic; Nurse-Patient Relations; Patient Handoff; Patient Satisfaction; Teaching Rounds; United Kingdom
PubMed: 27081733
DOI: 10.12968/bjon.2016.25.7.386 -
World Journal of Surgery Jan 2023Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present... (Review)
Review
BACKGROUND
Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature.
METHODS
A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system.
RESULTS
A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy.
CONCLUSIONS
These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
Topics: Humans; Enhanced Recovery After Surgery; Preoperative Exercise; Teaching Rounds; Liver
PubMed: 36310325
DOI: 10.1007/s00268-022-06732-5 -
Family Medicine Apr 2022
Topics: Humans; Internship and Residency; Teaching; Teaching Rounds
PubMed: 35421249
DOI: 10.22454/FamMed.2022.666916 -
Diagnosis (Berlin, Germany) Aug 2019Background Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health...
Background Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created both challenges and opportunities for such communication. Methods We conducted a multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals. Physician teams were observed during and after morning rounds to understand workflow, data sharing and communication during diagnosis. To validate findings, interviews and focus groups were conducted with physicians. Field notes and interview/focus group transcripts were reviewed and themes identified using content analysis. Results Existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making. Further, the EHR created data overload and data fragmentation, making integration for diagnosis difficult. To improve diagnosis, physicians recommended replacing pagers with two-way communication devices, restructuring the EHR to facilitate access to key information and improving training on EHR systems. Conclusions As advances in health information technology evolve, challenges in the way clinicians share information during the diagnostic process will rise. To improve diagnosis, changes to both the technology and the way in which we use it may be necessary.
Topics: Anthropology, Cultural; Communication; Diagnosis; Electronic Health Records; Focus Groups; Humans; Information Dissemination; Inpatients; Internal Medicine; Interviews as Topic; Medical Informatics; Physicians; Teaching Rounds
PubMed: 30485175
DOI: 10.1515/dx-2018-0036 -
BMJ (Clinical Research Ed.) Dec 2018To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of... (Clinical Trial)
Clinical Trial
OBJECTIVE
To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds.
DESIGN
Prospective, multicenter before and after intervention study.
SETTING
Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017.
PARTICIPANTS
All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents.
INTERVENTION
Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds ("family centered rounds"), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement.
MAIN OUTCOME MEASURES
Medical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting.
RESULTS
The overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-intervention 35.8 (26.9 to 47.7) post-intervention, P=0.21), but harmful errors (preventable adverse events) decreased by 37.9% (20.7 (15.3 to 28.1) 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) 5.2 (3.1 to 8.8), P=0.003). Top box (eg, "excellent") ratings for six of 25 components of family reported experience improved; none worsened. Family centered rounds occurred more frequently (72.2% (53.5% to 85.4%) 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) 35.5% (17.0% to 59.6%), P=0.03) on rounds improved. Families expressing concerns at the start of rounds (18.2% (5.6% to 45.3%) 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) 26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly.
CONCLUSIONS
Although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02320175.
Topics: Adult; Child; Child, Preschool; Communication; Family; Female; Humans; Inpatients; Male; Medical Errors; North America; Patient Care Team; Patient Participation; Patient Safety; Patient-Centered Care; Professional-Family Relations; Program Evaluation; Prospective Studies
PubMed: 30518517
DOI: 10.1136/bmj.k4764 -
Medical Science Educator Sep 2019
PubMed: 34457553
DOI: 10.1007/s40670-019-00741-1 -
Interactive Journal of Medical Research Nov 2022Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds. (Review)
Review
BACKGROUND
Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds.
OBJECTIVE
This systematic review examines perceptions of education in ward rounds, educational activities in ward rounds, barriers to learning, and perceptions of simulation-based ward rounds.
METHODS
The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MEDLINE (EBSCO), Cochrane, and Scopus were searched on May 29, 2022, for studies assessing learning during ward rounds. The search terms included "ward rounds," "education," and "trainees." Then, the selected articles were reference searched. In total, 354 articles were retrieved. The articles were assessed for eligibility by 2 independent reviewers who screened titles, abstracts, and full-length texts. Articles addressing trainees' education in all ward rounds were included. Articles were excluded if they were specific to certain disciplines, were reviews, were not published in scholarly journals, were published before 2015, were published in languages other than English, or did not concern human participants. Following the removal of 63 duplicates, a total of 268 articles were excluded. The risk of bias within the selected articles was also assessed via the Critical Appraisal Skills Programme checklist for qualitative research. Qualitative data were used to describe results in a narrative synthesis and in tables.
RESULTS
A total of 23 articles were included. Perceptions of teaching in rounds were addressed by 6 studies, of which 3 showed negative perceptions among participants, 2 reported ambivalent perceptions, and 1 showed positive perceptions. Perceived barriers to teaching during rounds were assessed by 7 studies. The reported barriers included time constraints, workloads, schedules, interruptions, the service-oriented nature of rounds, the lack of feedback, hierarchies, the lack of opportunities to ask questions and be engaged in patient management, and divergent learner needs. Further, 8 studies identified types of educational activities, including observation, patient-specific teaching, and discussion. Perceptions of learning through simulated ward rounds were assessed by 8 studies, and a consensus of satisfaction was noted among learners. The interventions that were explored to improve education included using teaching frameworks, involving clinical librarians, and changing the setting of ward rounds.
CONCLUSIONS
The main limitations of this review are the predominant use of qualitative data in the included articles and the lack of standardization for the educational compositions of ward rounds among articles, which made the articles hard to compare. In conclusion, learning opportunities in ward rounds are often missed, and trainees perceive rounds to have low educational value. It is important to recognize the barriers to education during ward rounds and address them to maximize the benefits of ward rounds. Finally, there is a need to develop plans that incorporate teaching regularly during ward rounds in the inpatient setting.
TRIAL REGISTRATION
PROSPERO CRD42022337736; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337736.
PubMed: 36285742
DOI: 10.2196/40580 -
Chest Dec 2020Racism and events of racial violence have dominated the US news in 2020 almost as much as the novel coronavirus pandemic. The resultant civil unrest and demands for... (Review)
Review
Racism and events of racial violence have dominated the US news in 2020 almost as much as the novel coronavirus pandemic. The resultant civil unrest and demands for racial justice have spawned a global call for change. As a subset of a society that struggles with racism and other explicit biases, it is inescapable that some physicians and health-care employees will have the same explicit biases as the general population. Patients who receive care at academic medical centers interact with multiple individuals, some of whom may have explicit and implicit biases that influence patient care. In fact, multiple reports have documented that some physicians, health-care workers, and health professional students have negative biases based on race, ethnicity, obesity, religion, and sexual identity, among others. These biases can influence decision-making and aggravate health-care disparities and patient-physician mistrust. We review four actual cases from academic medical centers that illustrate how well-intended physicians and health-care workers can be influenced by bias and how this can put patients at risk. Strategies to mitigate bias are discussed and recommended. We introduce what we believe can be a powerful teaching tool: periodic "bias and racism rounds" in teaching hospitals, in which real patient interactions are reviewed critically to identify opportunities to reduce bias and racism and to attenuate the impact of bias and racism on patient outcomes.
Topics: Academic Medical Centers; Attitude of Health Personnel; Healthcare Disparities; Humans; Physician-Patient Relations; Prejudice; Racism; Teaching Rounds
PubMed: 32882252
DOI: 10.1016/j.chest.2020.08.2073 -
Cureus May 2020Education has continued to evolve since the existence of mankind. We have now become more well-equipped and refined our teaching methodology over time. Despite all the... (Review)
Review
Education has continued to evolve since the existence of mankind. We have now become more well-equipped and refined our teaching methodology over time. Despite all the progress made, we still continue to rely on bedside huddle for teaching. Globalization has facilitated learning in culturally diverse environment. Grand rounds, noon lectures and conferences help the millennial house-staff to effectively translate their concepts to hands-on clinical experience. Useful teaching strategies like story-telling, connecting, simplifying, playing hierarchy make learning more fun and engaging. Multidisciplinary collaborative learning has eased conceptualization and retention of practical knowledge. Our education system now focuses more on patient-centered, case-based learning system.
PubMed: 32542154
DOI: 10.7759/cureus.8099 -
Hospital Pediatrics Feb 2022Despite widespread adoption of family-centered rounds, few have investigated differences in the experience of family-centered rounds by family race and ethnicity. The...
OBJECTIVE
Despite widespread adoption of family-centered rounds, few have investigated differences in the experience of family-centered rounds by family race and ethnicity. The purpose of this study was to explore racial and ethnic differences in caregiver perception of inclusion and empowerment during family-centered rounds.
METHODS
We identified eligible caregivers of children admitted to the general pediatrics team through the electronic health record. Surveys were completed by 99 caregivers (47 non-Latinx White and 52 Black, Latinx, or other caregivers of color). To compare agreement with statements of inclusivity and empowerment, we used the Wilcoxon rank sum test in unadjusted analyses and linear regression for the adjusted analyses.
RESULTS
Most (91%) caregivers were satisfied or extremely satisfied with family-centered rounds. We found no differences by race or ethnicity in statements of satisfaction or understanding family-centered rounds content. However, in both unadjusted and adjusted analyses, we found that White caregivers more strongly agreed with the statements "I felt comfortable participating in rounds," "I had adequate time to ask questions during rounds," and "I felt a valued member of the team during rounds" compared with Black, Latinx, and other caregivers of color.
CONCLUSIONS
Congruent with studies of communication in other settings, caregivers of color may experience barriers to inclusion in family-centered rounds, such as medical team bias, less empathic communication, and shorter encounters. Future studies are needed to better understand family-centered rounds disparities and develop interventions that promote inclusive rounds.
Topics: Caregivers; Child; Communication; Empathy; Humans; Surveys and Questionnaires; Teaching Rounds
PubMed: 35079809
DOI: 10.1542/hpeds.2021-006034