Prioritizing people and rapid learning in times of crisis: A virtual learning initiative to support health workers during the COVID-19 pandemic.

The Western Cape province was the early epicentre of the coronavirus disease 2019 pandemic in South Africa and on the African continent. In this short article we report on an initiative set up within the provincial Department of Health early in the pandemic to facilitate collective learning and support for health workers and managers across the health system, emphasising the importance of leadership, systems resilience, nonhierarchical learning and connectedness. These strategies included regular and systematic engagement with organised labour, different ways of gauging and responding to staff morale, and daily 'huddles' for raid learning and responsive action. We propose three transformational actions that could deliver health systems that protect staff during good times and in times of system shocks. (a) Continuously invest in building the foundations of system resilience in good times, to draw on in an acute crisis situation. (b) Provide consistent leadership for an explicit commitment to supporting health workers through decisive action across the system. (c) Optimise available resources and partners, act on improvement ideas and obstacles. Build trusting relationships amongst and across actors.

The impact of an electronic reminder on the use of alarms after separation from cardiopulmonary bypass.

INTRODUCTION: During cardiopulmonary bypass (CPB) monitor alarms are routinely disabled. Failure to reactivate these alarms after CPB may jeopardize patient safety. We have produced an electronic reminder that automatically alerts clinicians to reactivate alarms after CPB and have evaluated the alarm reactivation rate after its implementation. METHODS: We developed and implemented an algorithm that identifies separation from CPB by the return of pulsatile flow and of mechanical ventilation, and checks alarm status (activated, disabled or silenced). If alarms have not been reactivated after separation from CPB, an electronic reminder appears. Data were collected during three time periods: Stage I (304 patients)--baseline period before implementation of the electronic reminder; Stage II (256 patients)--after implementation; Stage III-(435 patients) after a single educational departmental meeting, at the end of Stage II. Incidence of proper alarm reactivation and the number of electronic reminders per patient were compared among stages. RESULTS: The rate of alarm reactivation at baseline (Stage I) was 22%, increased to 63% (Stage II), and again to 83% during Stage III (P < 0.001). The spontaneous alarm reactivation rate before the appearance of the electronic reminder on the anesthesia information management system screen increased from 19% at Stage II to 42% at stage III (P < 0.001). CONCLUSION: Introducing an automatic electronic reminder significantly increased the rate of alarm reactivation after separation from CPB. Real-time computerized decision-support tools can be developed within anesthesia information management system and may be useful for improving safety during anesthesia.

The feasibility of sharing simulation-based evaluation scenarios in anesthesiology.

UNLABELLED: We prospectively assessed the feasibility of international sharing of simulation-based evaluation tools despite differences in language, education, and anesthesia practice, in an Israeli study, using validated scenarios from a multi-institutional United States (US) study. Thirty-one Israeli junior anesthesia residents performed four simulation scenarios. Training sessions were videotaped and performance was assessed using two validated scoring systems (Long and Short Forms) by two independent raters. Subjects scored from 37 to 95 (70 +/- 12) of 108 possible points with the "Long Form" and "Short Form" scores ranging from 18 to 35 (28.2 +/- 4.5) of 40 possible points. Scores >70% of the maximal score were achieved by 61% of participants in comparison to only 5% in the original US study. The scenarios were rated as very realistic by 80% of the participants (grade 4 on a 1-4 scale). Reliability of the original assessment tools was demonstrated by internal consistencies of 0.66 for the Long and 0.75 for the Short Form (Cronbach alpha statistic). Values in the original study were 0.72-0.76 for the Long and 0.71-0.75 for the Short Form. The reliability did not change when a revised Israeli version of the scoring was used. Interrater reliability measured by Pearson correlation was 0.91 for the Long and 0.96 for the Short Form (P < 0.01). The high scores for plausibility given to the scenarios and the similar reliability of the original assessment tool support the feasibility of using simulation-based evaluation tools, developed in the US, in Israel. The higher scores achieved by Israeli residents may be related to the fact that most Israeli residents are immigrants with previous training in anesthesia. IMPLICATIONS: Simulation-based assessment tools developed in a multi-institutional study in the United States can be used in Israel despite the differences in language, education, and medical system.