Evaluating Radiology Result Communication in the Emergency Department.

PURPOSE: To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. METHODS: An institutional review board-approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. RESULTS: A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. CONCLUSIONS: Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?

A interdisciplinaridade na produção e divulgação do conhecimento em tempos de pandemia ­ um olhar da atual gestão da EEAAC / Interdisciplinariedad en la producción y difusión de conocimiento en tiempos de pandemia: una mirada a la gestión actual de EEAAC / Interdisciplinarity in the production and dissemination of knowledge in times of pandemic ­ a view of the current management of the EEAAC

Esse trabalho tem como objetivo realizar uma breve reflexão sobre a produção e divulgação de conhecimento na enfermagem e na saúde. Assim destaca-se o papel da EEAAC na produção do conhecimento inerente a enfermagem e a suas interfaces no contexto da pandemia. Preconiza-se uma produção de conhecimento integrado ao contexto social diante dos avanços da ciência. O OBJN tem uma função primordial na difusão de conhecimentos científicos de enfermagem e áreas afins. A atual gestão almeja avançar para que a revista tenha impacto significativo e acesso aberto.

Este artículo tiene como objetivo realizar una breve reflexión sobre la producción y difusión del conocimiento en enfermería y salud. Así, se destaca el papel de la EEAAC en la producción de conocimiento inherente a la enfermería y sus interfaces en el contexto de la pandemia. Se recomienda una producción de conocimiento integrada en el contexto social ante los avances de la ciencia. OBJN tiene un papel primordial en la difusión del conocimiento científico en enfermería y campos relacionados. La gestión actual tiene como objetivo avanzar para que la revista tenga un impacto significativo y un acceso abierto.

This paper aims to make a brief reflection on the production and dissemination of knowledge in nursing and health. Thus, the role of the EEAAC in the production of knowledge inherent to nursing and its interfaces in the context of the pandemic is highlighted. A production of knowledge integrated into the social context is recommended in view of the advances in science. The OBJN has a primary role in the dissemination of scientific nursing knowledge and related areas. The current management aims to move forward so that the journal has significant impact and open access.

COVID-19 in a community hospital.

The rapid spread of COVID-19 across the globe quickly and drastically changed the way we practice medicine. In order to respond to its effects, careful planning and implementation of new guidelines and protocols was crucial to ensure the safety of both patients and staff. Given the limitations of space, staff, and resources in the community hospitals, a centralized command center, robust lines of communication within the department and between departments, and contingency and surge planning in this setting were critical. This chapter focuses on the unique challenges of practicing within a Level II hospital during a global pandemic.

Sign in, time out, sign out checklist-changing practice through interdepartmental teamwork to improve safety at caesarean section.

Three similar clinical incidences over a three-month period highlighted an issue with the readiness and availability of neonatal resuscitation personnel and equipment at the time of caesarean section (CS). This identified a potential risk to the wellbeing of the mother and baby that had to be addressed. A joint venture was undertaken with the maternity and theatre directorates. A maternity-specific checklist in use in the UK maternity services was sourced, adapted and implemented. No further incidents have been reported since with resulting overall enhanced safety of pregnant women and newborn babies in the unit.

Standardized, Interdepartmental, Simulation-Based Central Line Insertion Course Closes an Educational Gap and Improves Intern Comfort with the Procedure.

Central line placement is a common procedure, routinely performed by junior residents in medical and surgical departments. Before this project, no standardized instructional course on the insertion of central lines existed at our institution, and few interns had received formal ultrasound training. Interns from five departments participated in a simulation-based central line insertion course. Intern familiarity with the procedure and with ultrasound, as well as their prior experience with line placement and their level of comfort, was assessed. Of the 99 interns in participating departments, 45 per cent had been trained as of October 2015. Forty-one per cent were female. The majority (59.5%) had no prior formal ultrasound training, and 46.0 per cent had never placed a line as primary operator. Scores increased significantly, from a precourse score mean of 13.7 to a postcourse score mean of 16.1, P < 0.001. All three of the self-reported measures of comfort with ultrasound also improved significantly. All interns reported the course was "very much" helpful, and 100 per cent reported they felt "somewhat" or "much" more comfortable with the procedure after attendance. To our knowledge, this is the first hospital-wide, standardized, simulation-based central line insertion course in the United States. Preliminary results indicate overwhelming satisfaction with the course, better ultrasound preparedness, and improved comfort with central line insertion.

Improving interdepartmental communication following a patient death.

When patients die in emergency departments (EDs), it is important to record information that can be shared with staff in other departments, such as the mortuary and bereavement office. This can be a time-consuming exercise but, if information is omitted, it can increase families' distress by delaying documents such as death certificates. This article describes how a new, tick-box-style death-in-department checklist was introduced in a London hospital adult ED to increase and improve communication and information sharing between the ED, the mortuary and the bereavement office. Audits undertaken before and after the introduction of the checklist show a 75% increase in the recording and sharing of information between relevant departments. The positive effect of the new checklist has led to its introduction in another, associated ED, and it has been incorporated into the trust's end of life care policy.

Além da rede de saúde mental: entre desafios e potencialidades / Más allá de la red de salud mental: entre desafíos y potencialidades / Beyond mental health’s network: between challenges and potentialities

Objective: to evaluate the challenges and the potentialities of the network of mental health from the Family Health Strategy. Methods: It is a descriptive and exploratory study, with qualitative methodological approach. The data collection occurred in the period of April to May 2012 in Family Health Units in the city of Pelotas, RS. There were performed semi-structured interviews with six managers, which were recorded and transcribed verbatim. Results: The challenges are highlighted by: lack of support from management, excessive use of psychotropic drugs, some professionals do not know their users and lack of communication on the network. The potentialities are: the recognition of the involvement of professionals with the actions of mental health and the concern of managers with the practices of mental health within their services. Conclusion: The care involves many social actors that need to work in network to mitigate the challenges and strengthen the potential to affect the care.

Objetivo: avaliar os desafios e as potencialidades da rede de saúde mental a partir da Estratégia de Saúde da Família. Método: Estudo descritivo e exploratório, com abordagem metodológica qualitativa. A coleta de dados ocorreu no período de abril a maio de 2012 em Unidades de Saúde da Família no município de Pelotas-RS. Foram realizadas entrevistas semiestruturadas com seis gestores, as quais foram gravadas e transcritas literalmente. Resultados: Os desafios são apontados pela: falta de apoio da gestão, uso excessivo de psicofármacos, alguns profissionais não conhecem seus usuários e falta comunicação na rede. As potencialidades são: o reconhecimento do comprometimento de profissionais com as ações de saúde mental e a preocupação dos gestores com as práticas de saúde mental dentro dos seus serviços. Conclusão: O cuidado envolve muitos atores sociais que precisam trabalhar em rede para amenizar os desafios e fortalecer as potencialidades para efetivar o cuidado.

Objetivo: evaluar los desafíos y las potencialidades de la red de salud mental a partir de la Estrategia de Salud de la Familia. Métodos: Consiste en un estudio descriptivo y exploratorio, con abordaje metodológica cualitativa. La recopilación de datos ocurrió en el periodo de abril a mayo de 2012 en Unidades de Salud de la Familia en el municipio de Pelotas-RS. Fueron realizadas entrevistas semiestructuradas con seis gestores,las cuales fueron grabadas y transcritas literalmente. Resultados: Los desafíos son apuntados por la falta de apoyo de la gestión, uso excesivo de psicofármacos, algunos profesionales no conocen sus usuarios y falta comunicación en la red. Las potencialidades son: el reconocimiento del comprometimiento de profesionales con las acciones de salud mental y la preocupación de los gestores con las prácticas de salud mental dentro de sus servicios. Conclusión: El cuidado envuelve muchos actores sociales que necesitan trabajar en red para amenizar los desafíos y fortalecer las potencialidades para efectuar el cuidado.

Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients.

OBJECTIVE: To assess the impact of the introduction of a dedicated management protocol of necrotizing otitis externa patients with joint care between otorhinolaryngology and infectious diseases. MATERIALS AND METHODS: Retrospective review of case notes and the otorhinolaryngology department database of all adults admitted with necrotizing otitis externa at our teaching hospital over a 5-year period. The patients were split into two groups (first group of 10 patients prior to the introduction of the dedicated management protocol, and a second group of 33 patients managed after the introduction of this protocol). RESULTS: Of the 43 patients included in the study, diabetes mellitus was present in 83.7%. Pseudomonas aeruginosa was grown in 67.4% of patients. All 43 patients underwent computed tomography and magnetic resonance imaging (with contrast) scans. Surgical intervention was undertaken in 25.6% of patients. Mean follow-up was 10 months (SD, ±7 months). Of the 43 patients, 79.1% made a full recovery and were discharged. Relapse occurred in 9.3% of patients. One patient died because of a myocardial infarction 4 months after treatment. The mean length of stay was significantly lower after the protocol was introduced (25.6±5.3 vs. 14.2±3.8 days, p=0.001), and the duration of treatment was also significantly lower after the protocol (21.2±6.8 vs. 14.3±4.3 weeks, p=0.01). CONCLUSION: The introduction of a dedicated management protocol and joint care with otorhinolaryngology and infectious diseases resulted in improved care and decreased length of stay in patients. Early diagnosis and involvement with the relevant teams as well as prompt intervention are the key factors that reduce morbidity and mortality.

Cultural implications of mentoring in sub-Saharan Africa: a qualitative study.

CONTEXT: Although many studies have demonstrated the benefits of mentoring in academic medicine, conceptual understanding has been limited to studies performed in North America and Europe. An ecological model of mentoring in academic medicine can provide structure for a broader understanding of the role of culture in mentoring. OBJECTIVE: The goal of this study was to explore the role of culture in the development and maintenance of mentoring relationships within the context of the University of Malawi College of Medicine. METHODS: A qualitative study using in-depth, semi-structured interviews and thematic analysis was conducted to explore the meaning of mentorship at the study institution. Criterion sampling was used to identify and recruit medical students, interns, registrars and faculty members. Study team members developed a codebook through open coding and applied it to all interview transcripts. Thematic analysis was used to identify and categorise themes according to an ecological model. RESULTS: A total of 46 participants from two major centres in Malawi were interviewed. Themes were identified within three domains: the intrapersonal; the interpersonal, and the institutional. Intrapersonal themes included Malawian politeness, mentoring needs, and friendliness and willingness to help. Interpersonal themes included understanding the role of the mentor, respect for elders, personal and professional boundaries, and perceptions of others. Institutional themes included the supervisor versus mentor, time pressures, tension about the scope of training, and the mentoring cycle. CONCLUSIONS: This study highlights the strengths of and challenges imposed by culture to the provision of mentoring relationships at the study institution. It also highlights the central role of culture in mentoring and proposes an updated model for mentoring in academic medicine. This model can inform future research on mentoring and may serve as a model in the larger effort to provide faculty development in mentoring across sub-Saharan Africa.

Does formal mentoring for faculty members matter? A survey of clinical faculty members.

BACKGROUND: Mentoring relationships, for all medical school faculty members, are an important component of lifelong development and education, yet an understanding of mentoring among medical school clinical faculty members is incomplete. This study examined associations between formal mentoring relationships and aspects of faculty members' engagement and satisfaction. It then explored the variability of these associations across subgroups of clinical faculty members to understand the status of mentoring and outcomes of mentoring relationships. The authors hypothesised that academic clinical faculty members currently in formal mentoring relationships experience enhanced employee engagement and satisfaction with their department and institution. METHODS: Medical school faculty members at 26 self-selected USA institutions participated in the 2011-2014 Faculty Forward Engagement Survey. Responses from clinical faculty members were analysed for relationships between mentoring status and perceptions of engagement by faculty members. RESULTS: Of the 11 953 clinical faculty respondents, almost one-third reported having a formal mentoring relationship (30%; 3529). Most mentored faculty indicated the relationship was important (86%; n = 3027), and over three-fourths were satisfied with their mentoring experience (77%; n = 2722). Mentored faculty members across ranks reported significantly higher levels of satisfaction and more positive perceptions of their roles in the organisation. Faculty members who were not receiving mentoring reported significantly less satisfaction with their workplace environment and lower overall satisfaction. CONCLUSIONS: Mentored clinical faculty members have significantly greater satisfaction with their department and institution. This multi-institutional study provides evidence that fostering mentoring opportunities may facilitate faculty members' satisfaction and engagement, which, in turn, may help medical schools retain high-quality faculty staff committed to the multidimensional academic mission.

Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities.

INTRODUCTION: The Canterbury earthquake of 22 February 2011 initiated a mass casualty event for Christchurch Hospital, which suffered damage itself, and faced logistical difficulties in continued operation. Radiology was part of the hospital-wide response. This paper reviews the radiology department response and surveys opinions of emergency doctors to provide an overview of events of the day and thoughts regarding any potential future response. METHODS: Two main approaches were undertaken: (i) informal data gathering and discussions with staff including radiographers, sonographers, radiologists, emergency doctors and others present on the day regarding their experiences; and (ii) survey of emergency doctors regarding their experiences and recommendations. A comparison with other similar events was also conducted. RESULTS: (1) Diagnostic radiology services were initially constrained by a lack of power and lift access. Usual imaging and reporting pathways were interrupted. Alternative processes were initiated to ensure an ongoing radiology service with available resources. Lessons were learned and changes implemented locally.(2) Survey data confirmed several primary outcomes: (i) Ultrasound was crucial while CT was down; (ii) all available imaging modalities remain important in a disaster response; and (iii) preliminary reports from radiologists in the emergency department (ED) were useful in the immediate post-earthquake period. CONCLUSION: Although resources were limited, a diagnostic radiology service remained operational. The Christchurch experience reinforces the need for disaster planning and rehearsal of plans.

[Emergency Department Interfaces]. / Schnittstelle Zentrale Notaufnahme.

Emergency Departments ED may be an exceptionally good example of an interface within a hospital. EDs have no patients of their own but pass them over to other institutions, either to specialist departments within the hospital or to primary care providers. Moreover, many doctors, nurses, attendants and institutions take part in the care of emergency department patients, and thus the number of its interfaces is very high. The characteristics of working in an ED, for example shortage of time, high work load, taking care of several patients at the same time and frequently crowding, may compromise the transfer of information via interfaces, sometimes including even vital data. The best way to secure handoff of information may be the formalization and standardization of this process, assuring patient safety and quality of care. Further study is required.

Management in Ambulance Services: Communicative Challenges.

Managers in ambulance services face many communicative challenges in their interaction with employees working as paramedics in prehospital medical practices. This series of three articles will focus on some of these challenges. This first article clarifies the context of manager-employee communication in ambulance work. The second article will present a study of how supervising ambulance managers and paramedics communicate, and the third will discuss how this communication can be improved. All the articles accentuate the same general point: organizational performance in prehospital medical practice depends on successful communication between managers and paramedics.

Articulação entre o conselho consultivo da Anvisa e o conselho nacional de saúde: uma análise no período de 2000 a 2010 / The relationship between the advisory board of Anvisa and the national health council: an analysis from 2000 to 2010

O estudo analisou os debates, no período de 2000 a 2010, no Conselho Nacional de Saúde (CNS) e na Comissão Intersetorial de Vigilância Sanitária e Farmacoepidemiologia (CIVSF), sobre os temas da vigilância sanitária e articulação com o Conselho Consultivo da Agência Nacional de Vigilância Sanitária (Anvisa). A pesquisa documental, de natureza qualitativa, que analisou 163 atas de reuniões do CNS e da CIVSF, e demais documentos a elas relacionados, buscou reunir informações sobre o contexto político-institucional e as interfaces e conexões entre as três instâncias. Observou-se baixa inserção do tema "vigilância sanitária" na pauta do CNS e uma atuação insuficiente da CIVSF para o fortalecimento desse debate. Conclui-se pela fragilidade de integração entre o Conselho Consultivo da Anvisa e as instâncias de controle social no Sistema Único de Saúde. Esse resultado é fruto de dificuldades de comunicação interinstitucional e da baixa inserção da vigilância sanitária no SUS, historicamente construída.

The study examined the discussions, in the period from 2000 to 2010, in the National Health Council (CNS) and the Inter-Sectoral Commission for Health Surveillance and Pharmacoepidemiology (CIVSF) about issues related to health surveillance and the articulation with the Consultant Council of the National Health Surveillance Agency (Anvisa). The documentary research, of qualitative nature, that analyzed 163 records of meetings of the CNS and CIVSF, and other documents related, sought to gather information about the political-institutional context and interfaces and connections between the three spaces. There was low insertion of the topic of health surveillance in the CNS agenda and insufficient performance of CIVSF to strengthen this debate. We conclude there is weak integration between the Advisory Council of Anvisa and social control agencies in the SUS. This is the result of difficulties in interagency communication and low insertion of health surveillance in SUS, historically constructed.