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J Clin Neurosci ; 92: 67-74, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509265


Errors in communication are a major source of preventable medical errors. Neurosurgical patients frequently present to the neuro-intensive care unit (NICU) postoperatively, where handoffs occur to coordinate care within a large multidisciplinary team. A multidisciplinary working group at our institution started an initiative to improve postoperative neurosurgical handoffs using validated quality improvement methodology. Baseline handoff practices were evaluated through staff surveys and serial observations. A formalized handoff protocol was implemented using the evidence based IPASS format (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, Synthesis by receiver). Cycles of objective observations and surveys were employed to track practice improvements and guide iterative process changes over one year. Surveys demonstrated improved perceptions of handoffs as organized (17.1% vs 69.7%, p < 0.001), efficient (27.0% vs. 72.7%, p < 0.001), comprehensive (17.1% vs. 66.7%, p < 0.001), and safe (18.0% vs. 66.7%, p < 0.001), noting improved teamwork (31.5% vs. 69.7%, p < 0.001). Direct observations demonstrated improved communication of airway concerns (47.1% observed vs. 92.3% observed, p < 0.001), hemodynamic concerns (70.6% vs. 97.1%, p = 0.001), intraoperative events (52.9% vs. 100%, p < 0.001), neurological examination (76.5% vs. 100%, p < 0.001), vital sign goals (70.6% vs. 100%, p < 0.001), and required postoperative studies (76.5% vs. 100%, p < 0.001). Receiving teams demonstrating improved rates of summarization (47.1% vs. 94.2%, p = 0.005) and asking questions (76.5% vs 98.1%, p = 0.004). The mean handoff time during long-term follow-up was 4.4 min (95% confidence interval = 3.9-5.0 min). Standardization of handoff practices yields improvements in communication practices for postoperative neurosurgical patients.

Transferência da Responsabilidade pelo Paciente , Comunicação , Humanos , Unidades de Terapia Intensiva , Erros Médicos , Período Pós-Operatório
Semin Nephrol ; 40(3): 249-263, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32560773


In the past 20 years, a variety of social media platforms have significantly changed how we interact, communicate, learn, and engage. Social media use by physicians and physicians in training has expanded dramatically and evolved in recent years. Here, we focus on the use of Twitter by medical professionals (#medtwitter) and analyze Twitter's role as a new tool for learning, teaching, networking, professional development, mentorship/sponsorship, and advocacy within medicine. We discuss principles of adult learning theory to support the effectiveness of the use of Twitter as an educational tool, and share best practice pearls as well.

Educação Médica , Disseminação de Informação , Nefrologia , Médicos , Comunicação Acadêmica , Mídias Sociais , Conflito de Interesses , Defesa do Consumidor , Apresentação de Dados , Humanos , Fator de Impacto de Revistas , Mentores , Revisão da Pesquisa por Pares