Applying human factors to improve patient safety, morale and team working for oral pathology and medicine specialists.

BACKGROUND: Human error is inevitable, and therefore can be considered as a 'normal' part of everyday life. Unfortunately, error can never be eliminated completely. However, learning from our mistakes can help reduce problems in future. Fifty years ago, most clinicians paid little or no attention to the human factors (HF) that can affect individual and team performance. It has only been in the last 20-25 years that colleagues in healthcare have truly begun recognizing the importance of HF and non-technical skills in medicine and dentistry and how their application can significantly improve patient safety and aid better team working and staff morale in the clinical setting and laboratory. DISCUSSION: Personal factors such as stress, tiredness, hunger and dehydration all reduce human performance and can raise the risk of mistakes. In addition, how we work and interact with the wider team is important since many errors can occur because of ineffective communication, steep hierarchal (authority) gradients and loss of situational awareness.  This short HF overview in the 50th commemorative special of JOPM issue is timely. It provides a contemporary overview of human factors and performance that the authors consider important for oral medicine and pathology colleagues and which can affect individuals and teams This article also discuss ways to reduce the chances of medical and dental error and improve patient safety.

Project Wingman - A short survey of staff perception and lounge benefit in a large UK NHS Trust.

Project Wingman is a novel initiative conceived early in the COVID-19 pandemic by two airline captains and a psychologist, which brings airline style lounges, staffed by volunteer air crew to NHS Trusts. The aim was to boost morale by providing airline style customer service for staff while on breaks. Over 50 lounges were opened across the NHS, staffed by up to 5000 volunteers. In this pilot study of one large Trust, we surveyed staff who visited the Wingman lounge. 100 completed questionnaires were used as an end point. All staff felt that the lounge was beneficial during COVID. 62% reported that they would visit the lounge even it was not attended by aircrew. 57% felt their wellbeing had suffered during the pandemic. A national study would be useful to assess the impact of the Wingman Lounges, but our pilot study highlights the importance of staff wellbeing and the value of taking breaks while at work. Many of the lessons learned in supporting colleagues during the pandemic could be used and adapted to help future wellbeing initiatives and aid retention of staff across the NHS.

Application of human factors at hybrid meetings: facilitating productivity and inclusivity.

The COVID-19 pandemic has resulted in the widespread use of virtual meetings and conferences. As the healthcare sector attempts to return to normality, face-to-face meetings have started to resume. However, ongoing travel restrictions, risk of viral transmission, the Omicron variant, and requirements for self-isolation, have necessitated the use of novel hybrid meeting formats. These enable participants to attend either in person or virtually using various online platforms such as Microsoft Teams and Zoom. Well organised and facilitated hybrid meetings can combine the advantages of in-person meetings with virtual participation, although the dynamics of communication between attendees is considerably different. This article discusses the benefits and pitfalls of the hybrid format, the human factors that impact productivity and inclusivity, and how to address them in future meetings.

Human factors application for healthcare teams in low- and medium-income countries (LMIC) to help improve patient safety and performance.

Mistakes will always happen whether at work or in our personal lives. We can never completely eliminate error, but learning and disseminating lessons from these mistakes to others is essential. Human factors application for colleagues in healthcare, particularly in low- and medium-income countries (LMIC) can greatly improve patient safety and aid better team working and staff morale. Factors such as hunger, dehydration anger, and tiredness, all reduce personal performance and can raise the risk of personal error. It is vital that we understand and optimize interaction within the healthcare team members. As part of this, ineffective communication, steep hierarchy and loss of situational awareness can lead to compromised patient safety and potentially serious error. In this paper, we provide a brief overview of human factors for healthcare colleagues in LMIC. We highlight ways to reduce the chances of error and improve patient safety by recognizing and applying various human factors to our day to day practices.

European Association of Oral Medicine 2021 Conference - Crispian Scully Lecture: Applying Human Factors to Improve Patient Safety and Performance.

BACKGROUND: This paper is a synopsis of the Crispian Scully Lecture, presented by one of the authors (PAB), at the 2021 European Association of Oral Medicine (EAOM) Conference in Lisbon, Portugal. It provides an overview of human factors that affect individuals and teams, highlighting ways to reduce the chances of error and improve patient safety. DISCUSSION AND CONCLUSION: Error is an inevitable and 'normal' part of being human, and it can never be completely eliminated, though learning from mistakes is essential. Human factor application in health care can greatly improve patient safety and lead to better team working and staff morale. Personal factors including tiredness, hunger, dehydration and stress can all reduce performance and raise the risk of clinical error. It is also important to understand and optimise interaction within the clinical team. Poor communication, steep hierarchy and loss of situational awareness can all potentially compromise patient safety.

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge.

Together with the ongoing serious COVID-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in COVID-19-recovered patients. Colloquially known as 'black fungus', mucormycosis commonly causes necrosis in the head and neck including the nose, paranasal sinuses, orbits, and facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that it progresses rapidly and diagnosis is often delayed. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic. Typically, the disease has been found to be linked to COVID-19 infections caused by the B.1.617.2 (Delta) variant, which has spread rapidly throughout the country. This variant has already become a cause for global concern, having spread to at least 40 countries, including the USA and UK. We present the findings of a study conducted on COVID-19 associated mucormycosis (CAM) patients, and discuss the associated risk factors to raise awareness for OMFS colleagues.

Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women.

OBJECTIVE: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer. METHODS: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted. RESULTS: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases. CONCLUSIONS: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.

Human factors awareness and recognition during multidisciplinary team meetings.

Multidisciplinary team (MDT) meetings are widely used throughout medicine and dentistry, bringing together expertise and different opinions across many disciplines to benefit patient care. Depending on the cancer site and specialties involved, some MDTs can last for several hours, especially if there are many complex patients to discuss. However, concentration and attention can vary and distraction is almost inevitable with separate conversations between MDT members and the ever-increasing use of smartphones. The role of human factors (HF) in contributing to error is well known in high-risk activities including medicine and surgery. Surprisingly, while there is increasing awareness of their importance by medical and dental professionals to enhance patient safety, to our knowledge nothing to date has been published about the possible effect and role of HF at MDTs. Here we provide a brief HF overview and focus on the factors at an MDT that could lead to distraction, providing suggestions (including some from aviation) for possible ways to enhance and improve discussion during these often-long meetings. It is hoped that this paper will generate some thought and discussion around the current "normal" MDT practice in head and neck and other specialties and challenge colleagues to embrace HF and safety principles in a just and learning culture.

WITHDRAWN: CT staging in breast cancer: Can we select patients requiring staging with CT?

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Educational article: what gets accepted for presentation?--a study of submitted abstracts for the 2009 BAOMS Conference.

The Annual Scientific Conference of the British Association of Oral and Maxillofacial Surgeons (BAOMS) provides an opportunity for colleagues to present papers to their peers, which can be beneficial both for professional development and for trainees to enhance their future career prospects. Each year far more abstracts are submitted than slots are available for oral presentation. These abstracts are reviewed by a paper selection committee, made up of several BAOMS colleagues. To our knowledge, there have not been any previous studies that have evaluated whether the type of study submitted (retrospective study, audit, prospective and so on) or the surgical sub-specialty is more likely to be accepted for presentation. Of 237 abstracts submitted for oral presentation at the 2009 conference, 99 were accepted (42% overall acceptance rate). Oncology and salivary gland disease formed the greatest proportion of total submissions (23%) followed by miscellaneous clinical papers (19%). The commonest type of submissions were retrospective studies (19%) followed by case report/series (15%). The greatest acceptance rate in this series was for orthognathic and TMJ papers (P<0.01) while for type of presentation, research/laboratory studies, technical procedures and randomised trials were most likely to be accepted (P<0.01 for all). It is possible that there are a certain number of slots allocated for presentation in each sub-category, which may increase competition in certain areas, but further work is necessary in this area. We recommend some general points for the successful acceptance of abstracts.

Fine needle aspiration cytology (FNAC) of salivary gland tumours: repeat aspiration provides further information in cases with an unclear initial cytological diagnosis.

INTRODUCTION: Fine needle aspiration cytology (FNAC) for salivary gland tumours requires expertise in interpretation. When a diagnosis is not clear (despite a cellular aspirate), published work is lacking on the value of repeating the test. METHODS: A retrospective study of 135 patients who had FNAC followed by definitive excision for a suspected salivary gland tumour. Accuracy was compared among those requiring repeat FNAC on one more occasion because of a non-diagnostic initial cytology report. RESULTS: 33 patients (24% of study group) had repeat FNAC. A definite cytological diagnosis was subsequently made in 27/33 patients (82%). The sensitivity (84%) and specificity (93%) of repeat FNAC in distinguishing benign from malignant tumours was similar to initial FNAC (70% and 95%, respectively). CONCLUSIONS: Repeat FNAC may provide a cytological diagnosis in cases where the initial diagnosis is not clear, although cytology should be used in conjunction with other investigations of salivary tumours, including image-guided biopsy examination where appropriate. Ideally salivary gland FNAC should be interpreted by a specialist pathologist.

An update on the use of ultrasound imaging in oral and maxillofacial surgery.

Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5-12 MHz) produces high definition multi-planar images. The spatial resolution achieved is superior to other methods of cross-sectional imaging and, when combined with tissue biopsying techniques such as fine needle aspiration cytology (FNAC) or core biopsy samples, it is rendered a highly specific diagnostic tool. This article provides an overview of the use of ultrasound for common head and neck conditions, including its use in salivary gland disease, and for the assessment of cervical lymphadenopathy.

CT and duplex scanning: a comparison of imaging techniques for evaluation of the carotid tree in head and neck cancer patients.

Carotid artery disease is a common condition which, like head and neck cancer, is primarily smoking related. Internal carotid stenosis may result in cerebro-vascular complications, while severe stenosis of the external carotid can potentially compromise microvascular free tissue transfer reconstruction. We were interested to see whether any co-existing carotid artery disease could be assessed on the neck CT scan by comparing it to definitive duplex scanning in head and neck cancer patients. CT and duplex scanning of the common, internal and external carotid arteries was compared in 30 patients (180 vessels). The arterial phase of the neck CT scans were reviewed by two radiologists and all duplex scans were performed by one vascular technician to minimise inter-operator variability. The respective findings were blinded. Significant correlations were found between CT and duplex in confirming stenosis of the common and internal carotid arteries (P<0.001). There was a weak correlation between CT and duplex in the assessment of the external carotid system (P=0.02 and P=0.08), with CT under-estimating the true extent of stenosis in this vessel. The sensitivity and specificity of CT compared to duplex was 77% and 94% respectively. CT is useful not only for imaging the neck of head and neck cancer patients, but also in screening for carotid stenosis. Duplex scanning is more accurate than CT in assessing the external artery, and is useful for evaluating patients with significant stenosis of the carotid tree.