Objectives & BackgroundThere has been an increasing use of massive haemorrhage protocols (MHP) within our trust. A number of clinical incidents were noted around roles/responsibilities when MHPs were run. Design failures (latent errors) were felt to contribute to these. Most MHPs are untested and are reliant on clear protocols, good communication and efficient team work. We proposed that running drills of our MHP in the ED setting would allow us to identify the latent errors and human factors that exist in our MHP then addressing these.MethodsWe proposed a 2 stage process where initially we tested functionality then identified and changed aspects of the system.FunctionalityWe ran 5 in-situ, real time MHP simulations involving the relevant members of the MDT in the ED. The 20 minute scenarios were followed by a structured human factors debrief. This allowed us to establish latent errors that were affecting the MHP. Results were then collated and codified from the sessions to allow planning of teaching for ED and non-ED staff.RedesignFollowing this a card redesign was identified as being necessary. We used the principles of negative space, contrast, proximity and the pictorial superiority effect. A cluster randomised recall trial was then conducted at an F2 teaching session (66 participants), with participants blinded to the other version of the cards. A trauma video was shown (thoracotomy) and recall measured after this. Data analysed by an author blinded to both the study design and the data collection. GAfREC permission given by R+D.ResultsHF/Ergonomics phase1. Difficulty identifying team members/roles2. Communication difficulties-same task being undertaken by multiple staff members3. Notes/ID labels not given to trauma team leader (TTL). TTL felt to be unapproachable4. Porters not feeling able to identify themselves5. Action cards and protocol not used-text heavy6. Staff not realising action cards were double sided7. Blood forms unavailable8. Poor prioritisation/labelling of the crossmatch sample9. Pre-arrival preparation steps being omittedCard redesign phase18 people recalled all the important information – all used the new cards. 0 people in the old card group recalled all the information. 66 of the f2s (100%) preferred new design of card.ConclusionHF principles helped identify areas for improvement. Utilising design principles appears to have had significant impact on the effectiveness of the cards.
Objectives & BackgroundPoor communication is at the heart of most complaints within the NHS. Failure to understand what a healthcare professional is saying can lead to confusion, fear, and complaints. We constructed a pilot study to understand the level of patients' comprehension of common statements heard in the emergency department setting.MethodsOver one week in 2015 we surveyed patients about their understanding of commonly heard medical expressions at a MTC in the W. Midlands. This was a convenience sample (due to team availability), but not restricted to any specific time of day/night.We identified five statements that represented procedures, processes within hospitals, and diagnosis. The questionnaire was given out after the medical consultation. Following completion an answer sheet was provided along with the opportunity to ask any further questions that there might be. Answers were written, with assistance where needed.The the data was collated using Excel. Answers to the common statements were divided into three categories; full understanding, partial understanding and no understanding. An a priori sample size of 30 was decided upon, largely because this is the number that our trust feels comfortable with when performing patient experience work. GAfREC approval was given.Results29 questionnaires were completed. Only one of our five statements (“you've got a fracture”) was understood by over 50% of the sample.Statements most poorly understood appear to involve hospital specific process involving acronyms such as ‘You're going to AMU’ (90% had no understanding) and ‘The ITU Reg is going to come and see you’ (76% had no understanding).Patients understand little of what we say to them and this gets worse the more acronyms we use.Despite this most patients felt the doctor and the nurse explained things well. This may reflect staff taking the time to explain medical terminology in the context of the patient's specific problem or pathology. Patients and relatives also reported that they were asked if they had any questions.ConclusionIt is unreasonable to assume patients understand commonly used medical terminology, Although medical terminology may be ubiquitous in a place of work it has the potential to be both profession and location specific. It is easy to forget this. As healthcare professionals we need to communicate using language the patient can understand and allow the patient an opportunity to ask for clarification.
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