Improving Escalation of Care

Johnston, Maximilian J.; Arora, Sonal; Pucher, Philip H.; Reissis, Yannis; Hull, Louise; Huddy, Jeremy R; King, Dominic; Darzi, Ara

doi:10.1097/sla.0000000000001164

Cited by 15 publications

(11 citation statements)

References 69 publications

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“…A recent study has confirmed the effect of teaching surgeons a systematic approach in escalation of care, emphasizing that it takes more than a guideline to deliver high‐quality treatment. In the AHA study, a part of the intervention was to create focus on the vulnerable population of patients undergoing high‐risk emergency surgery and address pitfalls in treatment.…”

Section: Discussionmentioning

confidence: 95%

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Tengberg

Bay‐Nielsen

Bisgaard

et al. 2017

British Journal of Surgery

120

150

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Section: Discussionmentioning

confidence: 95%

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Tengberg

Bay‐Nielsen

Bisgaard

et al. 2017

British Journal of Surgery

120

150

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“…Toolkits have also been developed in the form of checklists to capture clinical skills, team interaction skills and doctor–patient interactions during a SWR [ 56 ]. Recently, a Quality of Information Transfer Tool has been developed and validated to further improve and directly combat the communication failures within WRT members and poor escalation of care, which previous tools such as SBAR have failed to address [ 57 ]. This objective training tool incorporates key clinical information and a solid presentation structure, whilst assessing the efficacy of communication skills training during escalation of care.…”

Section: Resultsmentioning

confidence: 99%

“The Longest Way Round Is The Shortest Way Home”: An Overhaul of Surgical Ward Rounds

et al. 2017

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BackgroundWard rounds, a keystone of hospital surgical practice, have recently been under the spotlight. Poor-quality ward rounds can lead to a greater number of adverse events, thereby cascading to an increased financial strain on our already burdened healthcare systems. Faced with mounting pressures from both outside and inside health organizations, concerted efforts are required to restore it back into prominence where it can no longer take a backseat to the other duties of a surgeon.MethodsThe nucleus of this narrative review is derived from an extensive literature search on surgical ward rounds.ResultsIn this review, we focus on the need for reforms, current characteristics of surgical ward rounds, obstacles encountered by competing interests and proposed solutions in delivery of effective ward rounds that can meet with newly laid guidelines.ConclusionWard rounds should be standardized and prioritized to improve patient care.

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“…To determine whether the quality of referrals differed between the devices, we audio-recorded the referrals made by nurses using the pager while the data from referrals made by using Hark were automatically recorded on the app itself. We then assessed the data against a previously validated assessment tool called the QUality of Information Transfer Tool (QUIT) [ 26 ]. The QUIT is a 25-item, 7-category assessment tool comprising core components to measure the quality and content of information transfer.…”

Section: Methodsmentioning

confidence: 99%

“…Hark runs over mobile phones and tablet devices to support clinical task management. In doing so it builds on the specifications we defined to reduce adverse events associated with clinical handoff, prioritization of clinical tasks, failure to rescue, and escalation of care [ 3 , 11 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients

Patel¹,

Johnston²,

Cookson³

et al. 2016

J Med Internet Res

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BackgroundMost hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication.ObjectiveThe objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers.MethodsWe recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users’ satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses.ResultsWe recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100–121 versus pager median 77, range 39–104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included “enhances interprofessional efficiency,” “results in less disturbance,” “performed desired functions reliably,” and “allows me to clearly transfer information.”ConclusionsHark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care.

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Improving Escalation of Care

Abstract: A validated tool to assess information transfer for deteriorating surgical patients was developed and tested using simulation and real-time clinical scenarios. It may improve the quality and safety of patient care on the surgical ward.

Cited by 15 publications

References 69 publications

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

“The Longest Way Round Is The Shortest Way Home”: An Overhaul of Surgical Ward Rounds

Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients

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