Queensland Trauma Education (QTE): an innovative simulation program that addresses the needs and barriers of interprofessional trauma care education across a complex landscape.

INTRODUCTION: Effective trauma care requires the rapid management of injuries. Rural and remote areas face inequity in trauma care due to time, distance and resource constraints, and experience higher morbidity and mortality rates than urban settings. A training needs analysis (TNA) conducted with stakeholders across Queensland, Australia, revealed a lack of contextual, accessible and interprofessional trauma education for clinicians. The Clinical Skills Development Service and Jamieson Trauma Institute developed the Queensland Trauma Education (QTE) program to address these concerns. QTE comprises a face-to-face training course and open access to online training resources created and reviewed by trauma experts. QTE also supports local training through a statewide simulation network and free access to simulation training equipment. The aim of this article is to review the QTE program and assess the benefits to clinicians in both the delivery of education and the provision of trauma care. METHODS: To evaluate the QTE program, a desktop review was conducted. This included analyses of website data, course and website content, and facilitator, stakeholder, participant and user feedback. The data were evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, and the program's alignment with the original TNA outcomes was assessed. RESULTS: The results showed that QTE aligns with the identified training needs. Specifically, QTE provides trauma education that is relevant, sustainable, employs best practice, is locally delivered, provides continuous support, is multidisciplinary, multi-platformed, physically accessible and accredited by the Australasian College for Emergency Medicine. The review also highlights how QTE has effectively been reaching its target population, improves knowledge and skills, has become widely adopted, and been implemented and maintained with relative success. CONCLUSION: The innovative QTE program addresses the previous deficits in trauma education and meets the needs identified in the TNA. The review also reveals further opportunities for continuous improvement and program sustainability.

Examining the efficacy of vibrotactile displays for monitoring patient vital signs: Six laboratory studies of change detection and state identification.

Healthcare workers often monitor patients while moving between different locations and tasks, and away from conventional monitoring displays. Vibrotactile displays can provide patient information in vibrotactile patterns that are felt regardless of the worker's location. We examined how effectively participants could identify changes in vibrotactile representations of patient heart rate (HR) and oxygen saturation (SpO2). In Experiment 1, participants identified changes in HR and SpO2 with greater than 90% accuracy while using vibrotactile displays configured in either an integrated or a separated format. In Experiment 2, incidental auditory and visual cues were removed and performance was still greater than 90% for the integrated display. In Experiments 3 and 4, ongoing tasks with low or high task load were introduced; high load worsened participants' response accuracy and speed at identifying vital signs. In Experiments 5 and 6, alternative designs were tested, including a design with a seemingly more natural mapping of HR to vibrotactile stimulation. However, no design supported more accurate performance than the integrated display. Results are interpreted with respect to multiple resource theory, and constraints on conforming to design guidelines are noted. Vibrotactile displays appear to be viable and therefore potentially suitable for use in healthcare and other contexts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predicting clinical deterioration with Q-ADDS compared to NEWS, Between the Flags, and eCART track and trigger tools.

BACKGROUND: Early warning tools have been widely implemented without evidence to guide (a) recognition and (b) response team expertise optimisation. With growing databases from MET-calls and digital hospitals, we now have access to guiding information. The Queensland Adult-Deterioration-Detection-System (Q-ADDS) is widely used and requires validation. AIM: Compare the accuracy of Q-ADDS to National Early Warning Score (NEWS), Between-the-Flags (BTF) and the electronic Cardiac Arrest Risk Triage Score (eCART)). METHODS: Data from the Chicago University hospital database were used. Clinical deterioration was defined as unplanned admission to ICU or death. Currently used NEWS, BTF and eCART trigger thresholds were compared with a clinically endorsed Q-ADDS variant. RESULTS: Of 224,912 admissions, 11,706 (5%) experienced clinical deterioration. Q-ADDS (AUC 0.71) and NEWS (AUC 0.72) had similar predictive accuracy, BTF (AUC 0.64) had the lowest, and eCART (AUC 0.76) the highest. Early warning alert (advising ward MO review) had similar NPV (99.2-99.3%), for all the four tools however sensitivity varied (%: Q-ADDS = 47/NEWS = 49/BTF = 66/eCART = 40), as did alerting rate (% vitals sets: Q-ADDS = 1.4/NEWS = 3.5/BTF = 4.1/eCART = 3.4). MET alert (advising MET/critical-care review) had similar NPV for all the four tools (99.1-99.2%), however sensitivity varied (%: Q-ADDS = 14/NEWS = 24/BTF = 19/eCART = 29), as did MET alerting rate (%: Q-ADDS = 1.4/NEWS = 3.5/BTF = 4.1/eCART = 3.4). High-severity alert (advising advanced ward review, Q-ADDS only): NPV = 99.1%, sensitivity = 26%, alerting rate = 3.5%. CONCLUSION: The accuracy of Q-ADDS is comparable to NEWS, and higher than BTF, with eCART being the most accurate. Q-ADDS provides an additional high-severity ward alert, and generated significantly fewer MET alerts. Impacts of increased ward awareness and fewer MET alerts on actual MET call numbers and patient outcomes requires further evaluation.

Time without ventilation during intubation in neonates as a patient-centred measure of performance.

AIMS: Time without ventilation is often much longer than an intubation attempt, yet patient stability relies on effective gas exchange. We argue that in addition to existing performance criteria, intubation performance measures should include interruption to effective ventilation. METHODS: We reviewed video recorded resuscitations of 31 term and preterm newborns that included at least one intubation attempt. Time stamps were recorded at the end of mask ventilation, laryngoscope insertion and removal (laryngoscope duration), and re-commencement of ventilation via mask or endotracheal tube (ETT). Intubation attempts were defined as Successful (subsequent ventilation via ETT), or Failed (ETT incorrectly placed) or Withdrawn (laryngoscope removed before ETT insertion attempt). RESULTS: During intubation, total time without ventilation varied from 31 to 273s, compared to laryngoscope duration of 12-149s. Time without ventilation as Median [min-max] was greater for failed attempts 64 [48-273]s, yet laryngoscope duration was shortest for failed attempts 33 [21-46]s. Time between ceasing ventilation and commencing intubation was 5 [1-46]s suggesting room for improvement during transitions within the procedure. CONCLUSIONS: Time without ventilation is a more physiologically important measure of a resuscitation team's intubation expertise than laryngoscope duration. Since successful attempts took longer than failed attempts, emphasising haste during vocal cord visualisation and tube insertion may reduce success rates. Reducing the time without ventilation at either end of the procedure may be achievable with better team coordination and could be just as important to patient wellbeing as technical precision.

Attitudes toward others depend upon self and other causal uncertainty.

People who are high in causal uncertainty doubt their own ability to understand the causes of social events. In three studies, we examined the effects of target and perceiver causal uncertainty on attitudes toward the target. Target causal uncertainty was manipulated via responses on a causal uncertainty scale in Studies 1 and 2, and with a scenario in Study 3. In Studies 1 and 2, we found that participants liked the low causal uncertainty target more than the high causal uncertainty target. This preference was stronger for low relative to high causal uncertainty participants because high causal uncertainty participants held more uncertain ideals. In Study 3, we examined the value individuals place upon causal understanding (causal importance) as an additional moderator. We found that regardless of their own causal uncertainty level, participants who were high in causal importance liked the low causal uncertainty target more than the high causal uncertainty target. However, when participants were low in causal importance, low causal uncertainty perceivers showed no preference and high causal uncertainty perceivers preferred the high causal uncertainty target. These findings reveal that goal importance and ideals can influence how perceivers respond to causal uncertainty in others.