Implementation of the TALK© clinical self-debriefing tool in operating theatres: a single-centre interventional study.

BACKGROUND: Debriefing in operating theatre environments leads to benefits in mortality, efficiency, productivity, and safety culture; however, it is still not regularly performed. TALK© is a simple and widely applicable team self-debriefing method to collaboratively learn and improve. METHODS: An interventional study introducing TALK© for voluntary clinical debriefing was carried out in operating theatre environments in a UK National Health Service hospital over 18 months. It explored compliance with the Five Steps to Safer Surgery and changes in behaviour in surgical teams regarding consideration and completion of debriefing. RESULTS: Team briefing and compliance with the WHO surgical safety checklist were performed consistently (>95% and >98%, respectively) throughout the study, which included 460 surgical lists. Consideration of debriefing increased at all data collection periods after intervention, from 35.6% to 60.3-97.4% (P≤0.003). Performance of debriefing, which was 23.3% at baseline, reached 39% at 6 months (P=0.039). Team planning of actions for improvement during debriefing also increased (P<0.001). A decline in performance of debriefing and subsequent improvement actions was observed after 6 months, albeit rates were above baseline at 18 months. The most reported reason not to carry out a debriefing was 'lack of issues'. After implementation, nurses and allied healthcare professionals increased their contribution to initiating and leading debriefing. Reported barriers were <18% at baseline, and decreased after intervention. CONCLUSIONS: A simple intervention introducing TALK© for voluntary debriefing in theatres prompted significant changes in team behaviour and sustained growth regarding consideration and performance of debriefing, especially in the first 6 months.

A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study.

BACKGROUND: COVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom's response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. OBJECTIVE: We aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). METHODS: A federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners' pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers' secure environments, and to support federated cohort discovery queries and meta-analysis. RESULTS: A total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. CONCLUSIONS: CO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures.

Simulated laryngoscopy with supraglottic high-pressure source ventilation: an in vitro study of tracheal airflow to determine optimal positioning of laryngoscope and jet ventilation cannula.

PURPOSE: To investigate how variations in positioning of laryngoscope and location of jet cannula on the laryngoscope body influence tracheal airflow during simulated high-pressure source supraglottic (HPSV) jet ventilation laryngoscopy using an anatomical model. METHODS: A Broncho Boy Bronchoscopy model was modified to allow recording of tracheal airflow. A laryngoscope was suspended and positioned to simulate laryngoscopy. HPSV was delivered by a jet cannula attached to the body of the laryngoscope. Different combinations of laryngoscope angulation and cannula attachment were used and air flow recorded for each combination. Statistical analysis assessed the variations in flow. RESULTS: Significant statistical differences in flow effect (P < 0.05) were shown, indicating that laryngoscope position and attachment of jet cannula have a significant effect on tracheal airflow. Highest flows were achieved by anterior positioning of laryngoscope combined with anterolateral attachment of cannula (> 1 L/s) compared to downward or either side (< 0.6 L/s). CONCLUSION: Significant differences in tracheal airflow arise from different positions of both laryngoscope and jet cannula with supraglottic HPSV. Optimal locations for both are apparent and collaborative interaction with anaesthetist emphasised. The experimental setup could be a potential simulation tool.

Perception of simulation training in emergencies for dental sedation practitioners.

BACKGROUND: Simulation education is an important part of health care education and training. There is growing evidence to support the usefulness of simulation, especially in training for infrequently occurring situations, such as medical emergencies seen by dental practitioners. There are, however, few data on the longer term effects of simulation, including usefulness, relevance, emotional effect and ability to affect changes to daily practice. METHODS: Dentists and dental nurses who had undergone simulation training in medical emergencies for dental sedation practitioners undertook a semi-structured interview about their perception of the simulation experience. They explored recollection of the experience and its emotional weight, perception of usefulness and relevance, specific learning outcomes and changes to practice prompted by the simulation session. RESULTS: Participants reported finding the simulation sessions worthwhile, realistic, challenging and almost universally emotionally positive. In situ simulation training was particularly well received, both in terms of realism, as well as identifying system flaws in emergency drugs and equipment. Participants reported gaining both increased clinical knowledge and human factors skills, which were reflected in subsequent changes to their practice. There are few data on the longer term effects of simulation DISCUSSION: Our results support the usefulness and applicability of simulation education to training in medical emergencies for dental sedation practitioners. In particular, specific benefits reported from in situ sessions and in human factors concepts will prompt us to review the structure of our teaching to maximise the benefit to participants.