Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

–  Objective:  Dentofacial emergencies are a common presentation to the emergency department (ED) but there is little recent data on physicians’ knowledge, confidence and attitudes in handling these cases. Method:  A questionnaire was administered to 103 ED physicians. The sample was primarily drawn from London hospitals as well a smaller contribution from around the UK and included physicians with a range of experience and at different grades. Results:  The majority of the 102 participants (76.5%) did not receive any formal training in managing dentofacial emergencies. The percentage of participants who were happy to manage common dentofacial emergencies is as follows: dental trauma (20.4%); major facial trauma (39.8%); interpreting facial X‐rays (68.0%); and facial suturing (85.4%). When questioned 12.1% of the participants felt that ED physicians should be responsible for managing dental emergencies compared to 22.4% who felt that ED physicians should manage maxillofacial emergencies. Only 3.9% of the participants would opt to be treated by an ED doctor in the event of them presenting to the ED with a dental injury. The remaining 72.5% would prefer to be seen by a maxillofacial surgeon, 23.5% by a dentist and none of the participants opted to be seen by the emergency nurse practitioner. Conclusion:  ED physicians do not feel confident in managing some dentofacial emergencies. This may be attributed to a lack of training in this area as well as exposure to these types of emergencies. There is a need for greater awareness, validated guidelines and training resources for ED physicians to treat dentofacial emergencies as well more research in this field of emergency medicine.

This paper describes the evaluation of a two-day simulation training programme for staff designed to improve inpatient care and compassion in an older persons' unit. ObjectiveThe programme was designed to improve inpatient care for older people by using mixedmodality simulation exercises to enhance empathetic and compassionate care. MethodsHealthcare professionals took part in a) a one-day human patient simulation course with six scenarios and b) a one-day ward-based simulation course involving five one-hour exercises with integrated debriefing. A mixed-methods evaluation included observations of the programme, confidence rating scales and follow-up interviews with staff at 7-9 weeks post-training. ResultsObservations showed enjoyment of course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human-patient simulation (t= 9; df = 56; p<.001) and ward based exercises (t= 9.3; df= 76; p<.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients.Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons.Published in BMJ Quality and Safety, 22, 6, 495-505 Ross, Anderson, Kodate et al. (2013) 3 ConclusionThe study demonstrated that simulation is an effective method for encouraging dignified careand compassion for older persons by teaching non-technical skills which focus on team skills and empathetic and sensitive communication with patients and relatives.

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Aim The primary aim of this study was to examine the impact of age, gender and the stage of dementia on the results of an assistive technology intervention that make use of communication robots (com‐robots). The intervention was designed to improve the social participation and interactions of nursing home residents. While our previous study showed that the overall effects of com‐robot intervention were positive, it was unknown what impact age, gender and the stage of dementia of participants had on such an intervention. Methods This was a non‐randomized, multicenter quasi‐experimental intervention study conducted in residential care homes in Japan. Two types of com‐robots were introduced for 8 weeks after baseline evaluation. The World Health Organization's ICF was used for evaluating any changes present after the 8‐week intervention. In total, 78 residents (68 women, 10 men, 86.5 ± 7.7 years old) participated in the study. The Degree of Daily Life Independence Score for People with Dementia (DDLIS‐PD) was employed for measuring the stage of dementia. Results The results showed that the older participants aged ≥80 benefited more from the intervention than the younger cohort did (P < 0.05). A greater improvement was shown among those with a more advanced stage of dementia than those at a less advanced stage (P < 0.05), when using DDLIS‐PD. Conclusions The overall findings support the use of com‐robots within the context of a care team for older people with moderate dementia, and those who are aged ≥80 years. Geriatr Gerontol Int 2020; 20: 373–378.

a b s t r a c tLearning from patient safety incidents is difficult; information is often incomplete, and it is not clear which incidents are preventable or which intervention strategies are optimal. Effective group processes are vital for learning but few studies in healthcare have examined in depth the processes involved and whether they are effective. The aims of this study were to identify factors that facilitated and hindered the process of analysing incidents in teams and to develop and apply a framework of indicators of effective analytic processes. Incident review meetings in acute care and mental health care were observed. Full field notes were analysed thematically. A framework of process measures was developed and used to rate each meeting using the field notes. Reliability was analysed. Factors hindering analysis were lack of organisational support, high workload and a managerial, autocratic leadership style. Facilitating factors were participatory interactions and strong safety leadership. Process measures showed deficits in critiquing the causes of incidents, seeking further information, critiquing potential solutions and solving problems that crossed organisational boundaries, supporting observational data on the importance of effective leadership. Organisational legitimacy, administrative support, training, tools for incident analysis, effective well trained leaders who empower the team and sufficient resources to manage the high workload were all identified in this study as necessary changes to improve learning. Future studies could develop and validate the proposed framework of process indicators to provide a tool for teams to use as an aid to improve the analysis of incidents.

In the era of global ageing, amid political concerns about increasing care needs and long-term sustainability of current care regimes, most high-income economies are seeking to minimise the use of institutional care and to expand formal home care for their older populations. In long-term care reforms, concerns about public funding, formal providers and the paid care workforce are foremost. However, an integral yet hidden part of all these reforms is the stealthily growing role of family carers. This article aims to identify and spell out how developments in formal home care bring about different modes of increasing, encouraging and necessitating family care inputs, across welfare states. Using secondary sources, three different modes were identified, and the article outlines the logic of each mechanism, drawing on illustrative examples of policy dynamics in both European and Asian countries. Family care inputs have increased through policy changes that are not explicitly or primarily about family care, but rather about expansion or changes in formal care. In some cases, this is explicit, in other cases something that happens 'through the back door'. Nonetheless, in all cases there are implications for the family caregivers' time, health and employment options. Future studies are needed to examine longitudinal trends from a comparative perspective to confirm our findings and elucidate how government commitments to formal home care provision and financing interact with the changing nature and volume of family caregiving.

Despite widespread adoption of simulation-based training in medical education, there remains scepticism about its cost-effectiveness and long-term impact on patient outcomes. Medical simulation is well established in anaesthesia where it is considered an important educational tool. This review of key clinical anaesthesia literature is used as a case study of clinician uptake within a specialty and to investigate evidence for translational impact using both qualitative and quantitative data. We examined high-impact journal publications from 2001 to 2010 and extracted data covering authors, institutions, simulation modality, purposes of simulation, and various aspects of study design/methodology used. A total of 320 papers containing primary data were included. We found broad acceptance and uptake in anaesthesia with an increase in publications over the time period, mainly attributable to a steady increase in manikin studies. Studies using manikin technology (130/320; 41%) are distinguished as skills/performance studies (76; 58%) and studies focused on the use, testing, and validation of equipment (52; 40%). A total of 110 papers (34%) assessed the performance of technical and non-technical skills (68% and 32%, respectively). Growth in the use of structured checklists/validated tools to assess performance is mainly observed in the non-technical domain. Only 10% of these papers include follow-up data from the clinical environment. There is a lack of research examining performance transfer, sustainability, and direct patient outcomes and experiences. These publication patterns are instructive for those involved in medical educational and for other clinical specialties developing simulation.