Attention Among Health Care Professionals : A Scoping Review.

BACKGROUND: The concept of attention can provide insight into the needs of clinicians and how health systems design can impact patient care quality and medical errors. PURPOSE: To conduct a scoping review to 1) identify and characterize literature relevant to clinician attention; 2) compile metrics used to measure attention; and 3) create a framework of key concepts. DATA SOURCES: Cumulated Index to Nursing and Allied Health Literature (CINAHL), Medline (PubMed), and Embase (Ovid) from 2001 to 26 February 2024. STUDY SELECTION: English-language studies addressing health care worker attention in patient care. At least dual review and data abstraction. DATA EXTRACTION: Article information, health care professional studied, practice environment, study design and intent, factor type related to attention, and metrics of attention used. DATA SYNTHESIS: Of 6448 screened articles, 585 met inclusion criteria. Most studies were descriptive (n = 469) versus investigational (n = 116). More studies focused on barriers to attention (n = 387; 342 descriptive and 45 investigational) versus facilitators to improving attention (n = 198; 112 descriptive and 86 investigational). We developed a framework, grouping studies into 6 categories: 1) definitions of attention, 2) the clinical environment and its effect on attention, 3) personal factors affecting attention, 4) relationships between interventions or factors that affect attention and patient outcomes, 5) the effect of clinical alarms and alarm fatigue on attention, and 6) health information technology's effect on attention. Eighty-two metrics were used to measure attention. LIMITATIONS: Does not synthesize answers to specific questions. Quality of studies was not assessed. CONCLUSION: This overview may be a resource for researchers, quality improvement experts, and health system leaders to improve clinical environments. Future systematic reviews may synthesize evidence on metrics to measure attention and on the effectiveness of barriers or facilitators related to attention. PRIMARY FUNDING SOURCE: None.

Feeding gastrostomy in children with complex heart disease: when is a fundoplication indicated?

PURPOSE: Malnutrition is common among children with complex heart disease (CHD). Feeding gastrostomies are often used to improve the nutritional status of such patients. Our purpose was to evaluate a cohort of children with CHD following open Stamm gastrostomy without fundoplication. METHODS: We reviewed all CHD patients who underwent feeding gastrostomy placement from 1/1/2004 to 4/7/2015. Demographic data, cardiac diagnoses, operative details, post-operative complications, and the need for GJ feeding and fundoplication were examined. RESULTS: Open Stamm gastrostomy was performed in 111 patients. Median age at surgery was 37 weeks (3 weeks-13.7 years); average weight was 5.3 ± 4.9 kg. Thirty-four patients (30 %) experienced a total of 37 minor complications, including tube dislodgement after stoma maturation (20), superficial surgical site infection (13), mechanical failure (3), and bleeding (1). Three patients experienced a major complication (need for return to the OR or peri-operative death <30 days). Three patients required a subsequent fundoplication. Fifty-six surviving patients (62 %) continue gastrostomy feeds, of which 7 (13 %) patients require GJ feeds. CONCLUSION: Children with CHD tolerate an open Stamm gastrostomy well with minimal major complications. These results support very selective use of fundoplication in infants and children with CHD who require a feeding gastrostomy.

Concepts and metrics of clinician attention: a scoping review protocol.

INTRODUCTION: There is growing emphasis on the importance of both the cognitive and behavioural phenomenon of attention for clinicians engaged in patient care. Aspects of attention such as cognitive load, distraction and task switching have been studied in various settings with different methodologies. Using the protocol described here, we aim to systematically review the medical literature in order to map the concept of attention and to synthesise diverse concepts and methods under the broader category of research focused on 'attention'. METHODS AND ANALYSIS: Following the methodology described by the Joanna Briggs Institute and Arksey and O'Malley, our scoping review conducts an iterative search of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline (PubMed) and EMBASE (Ovid). An initial limited search based on key concepts and terminology will generate relevant articles which in turn will be mined for additional keywords and index terms to guide a formal literature search. Our multidisciplinary team will extract data into a matrix, including a small random sample of the same studies (to ensure concordance), and present the results in a descriptive narrative format. ETHICS AND DISSEMINATION: As a secondary analysis, our study does not require ethics approval, and we will ensure that included studies have appropriate approval. We anticipate results will identify diverse ways of conceptualising clinician attention and will provide a foundation for developing additional metrics and study methods to optimise attention in the clinical environment. We will disseminate results through journals and conferences and coordinate with colleagues doing work in adjacent fields.

Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments.

Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, its adoption among hospitalists has been slow. We performed semi-structured interviews of hospitals from four diverse health systems in the United States to understand determinants of adoption within a range of clinical settings. We used the diffusion of innovation theory to guide a framework analysis of the data. Of the 27 hospitalists invited, we performed 22 interviews from four hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: (1) There are important clinical advantages to LUS despite operator dependence, (2) LUS enhances patient and clinician experience, (3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and (4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite the perceived benefits of LUS for patients, clinicians and health systems, a significant barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.

Professional Formation in the Gross Anatomy Lab and Narrative Medicine: An Exploration.

As an early and important experience in medical education, dissection in the gross anatomy lab is a locus of professional formation. Because students often think of their professional development in evolving, narrative terms, the authors propose that close attention to these narratives might add to understanding of professional formation in progress. They solicited written reflections from students, to explore ways that both the content and form of written reflections might illuminate themes relevant to professional formation, and to describe some elements of professional formation in the context of one institution (Baylor College of Medicine, Houston, Texas). Seventeen students participated in writing sessions and wrote in response to an oral interview transcript and to a poem. Using a reading approach that grew out of the narrative medicine movement, the authors collaboratively engaged the content and form of these written reflections.Students' collection of written reflections was a rich source of information about their experiences in the anatomy lab. Through both content (e.g., expressions of gratitude, transitions, self-awareness) and form (e.g., from less detailed writing to literary playfulness), their writings gave a glimpse into the tensions, disappointments, and satisfactions of the practice of gross anatomy.This project models one way that educators can read and respond to the reflective writing that students generate. The authors go on to propose ways that interactions around reflective writing can be part of a broader goal of forming narrative-minded physicians, who become increasingly self- and other-aware as they progress in their education and practice.