Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Surg Res ; 274: 185-195, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35180495

RESUMO

INTRODUCTION: Intraoperative deaths (IODs) are rare but catastrophic. We systematically analyzed IODs to identify clinical and patient safety patterns. METHODS: IODs in a large academic center between 2015 and 2019 were included. Perioperative details were systematically reviewed, focusing on (1) identifying phenotypes of IOD, (2) describing emerging themes immediately preceding cardiac arrest, and (3) suggesting interventions to mitigate IOD in each phenotype. RESULTS: Forty-one patients were included. Three IOD phenotypes were identified: trauma (T), nontrauma emergency (NT), and elective (EL) surgery patients, each with 2 sub-phenotypes (e.g., ELm and ELv for elective surgery with medical arrests or vascular injury and bleeding, respectively). In phenotype T, cardiopulmonary resuscitation was initiated before incision in 42%, resuscitative thoracotomy was performed in 33%, and transient return of spontaneous circulation was achieved in 30% of patients. In phenotype NT, ruptured aortic aneurysms accounted for half the cases, and median blood product utilization was 2,694 mL. In phenotype ELm, preoperative evaluation did not include electrocardiogram in 12%, cardiac consultation in 62%, stress test in 87%, and chest x-ray in 37% of patients. In phenotype ELv, 83% had a single peripheral intravenous line, and vascular injury was almost always followed by escalation in monitoring (e.g., central/arterial line), alert to the blood bank, and call for surgical backup. CONCLUSIONS: We have created a framework for IOD that can help with intraoperative safety and quality analysis. Focusing on interventions that address appropriateness versus futility in care in phenotypes T and NT, and on prevention and mitigation of intraoperative vessel injury (e.g., intraoperative rescue team) or preoperative optimization in phenotype EL may help prevent IODs.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Lesões do Sistema Vascular , Parada Cardíaca/etiologia , Parada Cardíaca/prevenção & controle , Hemorragia , Humanos , Toracotomia
2.
Br J Anaesth ; 128(1): 3-7, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34776122

RESUMO

Managing a safe and efficient anaesthetic induction within a team involves the challenge of when, if, and how to surface, discuss, and implement the best plan on how to proceed. The Lemke and colleagues study in this issue of the British Journal of Anaesthesia is a unique view into real-world conversations that naturally occur in anaesthesia teams in moments of high task and cognitive load, such as induction of anaesthesia. The study spotlights important small moments of physician, nurse, and trainee team coordination. It illuminates key patterns of conversation in naturally occurring anaesthesia teams, and raises important questions about what the speaking up standard should be and the psychological safety-shaping role consultants play in setting the norms for speaking up.


Assuntos
Anestesiologia , Equipe de Assistência ao Paciente , Comunicação , Cuidados Críticos , Humanos
3.
Anesthesiol Clin ; 39(4): xv-xvi, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34776115
4.
AANA J ; 89(1): 1-6, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33543706

RESUMO

The expectation by colleagues that fellow clinicians deftly manage the stresses of practice often predisposes healthcare professionals involved in an adverse event to experience isolation, blame, and shame. The peer support model has since been recognized as an important component of institutional wellness and follows a well-described and structured method. Although peer support programs have traditionally been established to support caregivers involved in adverse medical events, the relevance and applicability of these programs have found substantial traction across broader crisis domains. Interventions, including peer support, help mitigate the 3 components of burnout: emotional exhaustion, depersonalization (cynicism), and reduced efficacy.


Assuntos
Esgotamento Profissional , COVID-19/enfermagem , Enfermeiras Anestesistas , Grupo Associado , SARS-CoV-2 , Humanos
5.
Anesthesiol Clin ; 38(4): 801-820, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33127029

RESUMO

Debriefing after perioperative crises (eg, cardiac arrest, massive hemorrhage) is a well-described practice that can provide benefits to individuals, teams, and health systems. Debriefing has also been embraced by high-stakes industries outside of health care. Yet, in studies of actual clinical practice, there are many critical events that do not get debriefed. This article explores the gap that exists between principle and reality and the factors and strategies to offer opportunities to reflect on actual critical events, when indicated, across the increasing scope of environments where anesthesia care is provided.


Assuntos
Anestesia , Anestesiologia , Anestesiologia/educação , Competência Clínica , Humanos
6.
Simul Healthc ; 15(4): 282-288, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32776776

RESUMO

STATEMENT: Many techniques and modifications commonly used by the simulation community have been identified as deceptive. Deception is an important issue addressed by both the newly adopted Healthcare Simulationist Code of Ethics and the American Psychological Association Code of Conduct. Some view these approaches as essential whereas others question their necessity as well as their untoward psychological effects. In an attempt to offer guidance to simulation-based healthcare educators, we explore educational practices commonly identified as deceptive along with their potential benefits and detriments. We then address important decision points and high-risk situations that should be avoided to uphold ethical boundaries and psychological safety among learners. These are subsequently analyzed in light of the Code of Ethics and used to formulate guidelines for educators that are intended to ensure that deception, when necessary, is implemented in as psychologically safe a manner as possible.


Assuntos
Decepção , Educação Médica/ética , Treinamento por Simulação/ética , Códigos de Ética , Educação Médica/organização & administração , Humanos , Treinamento por Simulação/organização & administração
8.
MedEdPORTAL ; 16: 10871, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-32051852

RESUMO

Introduction: Operating room (OR) fire can be a devastating and costly event to patients and health care providers. Prevention and effective management of such fires may present difficulties even for experienced OR staff. Methods: This simulation involved a 52-year-old man presenting for excisional biopsy of a cervical lymph node to be performed under sedation. Participants were expected to identify and manage both contained and uncontained fires resulting from ignition by electrosurgical cautery. We conducted weekly multidisciplinary simulations in the mock OR at Massachusetts General Hospital. Participants included surgery and anesthesiology residents, certified registered nurse anesthetists, registered nurses, and surgical technicians. Participants were unaware of the scenario content. Each 90-minute session was divided into three parts: an orientation (10 minutes), the case with rapid cycle debriefing (65 minutes), and a final debriefing with course evaluations (15 minutes). Equipment consisted of a simulation OR with general surgery supplies, general anesthesia equipment, a high-fidelity Laerdal SimMan 3G simulator, a code cart, a defibrillator, dry ice for smoke effects, and a projector with a fire image. Results: From April to June 2015, 86 participants completed this simulation. Participants reported that the simulation scenario was realistic (80%), was relevant to their clinical practice (93%), changed their practice (82%), and promoted teamwork (80%). Discussion: Prevention and management of OR fire require collaboration and prompt coordination between anesthesiologists, surgeons, and nurses. This simulation case scenario was implemented to train multidisciplinary learners in the identification and crisis management of such an event.


Assuntos
Anestesiologia/educação , Incêndios/prevenção & controle , Cirurgia Geral/educação , Internato e Residência , Salas Cirúrgicas , Simulação de Paciente , Cauterização , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Saúde do Trabalhador , Enfermagem Perioperatória
11.
MedEdPORTAL ; 14: 10688, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-30800888

RESUMO

Introduction: Resuscitation of a critically ill patient is challenging for both novice learners and experienced health care providers. During a critical event, not only is it important to identify the correct underlying diagnosis, it is equally crucial that the appropriate Advance Cardiac Life Support algorithm, medications, and defibrillator modality are implemented. This scenario features a 56-year-old female who presents for excisional biopsy of an inguinal lymph node to evaluate lymphadenopathy concerning for lymphoma. Intraoperatively, she goes into cardiopulmonary arrest. Participants must identify and manage three different scenarios: (1) ventricular fibrillation, (2) unstable ventricular tachycardia, and (3) bradycardia, including the use of the defibrillator. Method: Weekly simulation sessions were conducted in the in situ simulation operating room at Massachusetts General Hospital. Surgical residents, anesthesiology residents, nurses, and surgical technicians participated in a multidisciplinary operating room team. Each approximately 60-minute session included an orientation, the case, and the debriefing. Equipment included a simulation operating room with general surgery supplies, general anesthesia equipment, a high-fidelity SimMan patient simulator, a code cart, and a defibrillator. Results: Ninety-one multidisciplinary participants completed this scenario from September to December 2015. Participants reported that the scenario was applicable to their clinical practice (96%), promoted teamwork skills (88%), and encouraged interprofessional learning (94%). Discussion: Intraoperative cardiac arrest is a devastating event that can result in poor patient outcomes if the care team is not thoroughly prepared for crisis management. This simulation case scenario was implemented to train multidisciplinary learners in the identification and management of such an event.


Assuntos
Suporte Vital Cardíaco Avançado/educação , Arritmias Cardíacas/tratamento farmacológico , Simulação de Paciente , Suporte Vital Cardíaco Avançado/métodos , Arritmias Cardíacas/diagnóstico , Humanos , Complicações Intraoperatórias/tratamento farmacológico , Salas Cirúrgicas/métodos , Equipe de Assistência ao Paciente , Inquéritos e Questionários
12.
Curr Opin Anaesthesiol ; 30(6): 723-729, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28968282

RESUMO

PURPOSE OF REVIEW: Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. RECENT FINDINGS: Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness. SUMMARY: Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed.


Assuntos
Anestesia Obstétrica/métodos , Anestesiologia/educação , Treinamento por Simulação/tendências , Adulto , Competência Clínica , Feminino , Humanos , Equipe de Assistência ao Paciente , Gravidez
13.
Anesthesiol Clin ; 35(1): 59-67, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28131120

RESUMO

Interprofessional teams work together on the labor and delivery unit, where clinical care is often unscheduled, rapidly evolving, and fast paced. Effective communication is key for coordinated delivery of optimal care and for fostering a culture of community and safety in the workplace. The preoperative huddle allows for information sharing, cross-checking, and preparation before the start of surgery. Postoperative debriefings allow the operative team to engage in ongoing process improvement. Debriefings after adverse events allow for shared understanding, mutual healing, and help mitigating the harm to potential "second victims."


Assuntos
Comunicação , Parto Obstétrico , Trabalho de Parto , Equipe de Assistência ao Paciente , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Feminino , Humanos , Segurança do Paciente , Gravidez , Melhoria de Qualidade
14.
Anesth Analg ; 122(6): 1931-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27195636

RESUMO

The availability of labor analgesia is highly variable in the People's Republic of China. There are widespread misconceptions, by both parturients and health care providers, that labor epidural analgesia is harmful to mother and baby. Meanwhile, China has one of the highest cesarean delivery rates in the world, exceeding 50%. The goal of the nongovernmental No Pain Labor & Delivery (NPLD) is to facilitate sustainable increases in vaginal delivery rates by increasing access to safe neuraxial labor analgesia, thereby decreasing the cesarean delivery rate. NPLD was launched in 2008 with the stated goal of improving labor outcome in China by increasing the absolute labor epidural analgesia rate by 10%. NPLD established 10 training centers over a 10-year period. We hypothesized that increased availability of labor analgesia would result in reduced requests for cesarean delivery and better labor outcomes for mother and baby. Multidisciplinary teams of Western clinicians and support staff traveled to China for 8 to 10 days once a year. The approach involved establishing 24/7 obstetric anesthesia coverage in Chinese hospitals through education and modeling multidisciplinary approaches, including problem-based learning discussions, bedside teaching, daily debriefings, simulation training drills, and weekend conferences. As of November 2015, NPLD has engaged with 31 hospitals. At 24 of these sites, 24/7 obstetric anesthesia coverage has been established and labor epidural analgesia rates have exceeded 50%. Lower rates of cesarean delivery, episiotomy, postpartum blood transfusion, and better neonatal outcomes were documented in 3 impact studies comprising approximately 55,000 deliveries. Changes in practice guidelines, medical policy, and billing codes have been implemented in conjunction with the modernization of perinatal practice that has occurred concurrently in China since the first NPLD trip in 2008.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Prestação Integrada de Cuidados de Saúde , Parto Obstétrico/métodos , Saúde Global , Dor do Parto/terapia , Plantão Médico , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Cesárea , China , Competência Clínica , Parto Obstétrico/efeitos adversos , Educação Médica Continuada , Procedimentos Cirúrgicos Eletivos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Capacitação em Serviço , Dor do Parto/diagnóstico , Dor do Parto/fisiopatologia , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Gravidez , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Acad Med ; 91(4): 530-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26703413

RESUMO

PURPOSE: The authors addressed three questions: (1) Would a realistic simulation-based educational intervention improve speaking-up behaviors of practicing nontrainee anesthesiologists? (2) What would those speaking-up behaviors be when the issue emanated from a surgeon, a circulating nurse, or an anesthesiologist colleague? (3) What were the hurdles and enablers to speaking up in those situations? METHOD: The authors conducted a simulation-based randomized controlled experiment from March 2008-February 2011 at the Center for Medical Simulation, Boston, Massachusetts. During a mandatory crisis management course for practicing nontrainee anesthesiologists from five Boston institutions, a 50-minute workshop on speaking up was conducted for intervention (n = 35) and control (n = 36) groups before or after, respectively, an experimental scenario with three events. The authors analyzed videos of the experimental scenarios and debriefing sessions. RESULTS: No statistically significant differences between the intervention and control group subjects with respect to speaking-up actions were observed in any of the three events. The five most frequently mentioned hurdles to speaking up were uncertainty about the issue, stereotypes of others on the team, familiarity with the individual, respect for experience, and the repercussion expected. The five most frequently mentioned enablers were realizing the speaking-up problem, having a speaking-up rubric, certainty about the consequences of speaking up, familiarity with the individual, and having a second opinion or getting help. CONCLUSIONS: An educational intervention alone was ineffective in improving the speaking-up behaviors of practicing nontrainee anesthesiologists. Other measures to change speaking-up behaviors could be implemented and might improve patient safety.


Assuntos
Anestesiologia/educação , Barreiras de Comunicação , Comunicação Interdisciplinar , Segurança do Paciente , Treinamento por Simulação/métodos , Boston , Competência Clínica , Comunicação , Humanos , Salas Cirúrgicas , Cultura Organizacional , Inabilitação do Médico , Pesquisa Qualitativa , Estereotipagem , Incerteza , Gravação de Videoteipe
18.
Simul Healthc ; 10(3): 163-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25932710

RESUMO

STATEMENT: The use of deceptive methodology in simulation education is an emerging ethical controversy. At the 2014 International Meeting on Simulation in Healthcare, arguments for and against its use were debated by simulation experts. What emerged from this discussion was an apparent disconnect between current practice and existing empiric research on this subject. At present, no framework exists to guide the simulation community's exploration of this issue of deception.After reviewing the relevant psychological literature, we propose a framework delineating discrete elements and important relationships, which enables a comprehensive view of the factors germane to simulations that use deception. We further comment on key pedagogical and psychological issues in the context of this framework and define an agenda for further research. Educators are encouraged to use this framework when determining whether, when, and how deception might be used and, if used, how it can be ethically justified and carefully implemented.


Assuntos
Decepção , Treinamento por Simulação/ética , Treinamento por Simulação/métodos , Emoções , Meio Ambiente , Objetivos , Humanos , Ensino/ética
19.
Surgery ; 158(5): 1434-40, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25999257

RESUMO

BACKGROUND: Optimal team performance in the operating room (OR) requires a combination of interactions among OR professionals and adherence to clinical guidelines. Theoretically, it is possible that OR teams could communicate very well but fail to follow acceptable standards of patient care and vice versa. OR simulations offer an ideal research environment to study this relationship. The goal of this study was to determine the relationship between ratings of OR teamwork and communication with adherence to patient care guidelines in a simulated scenarios of malignant hyperthermia (MH). METHODS: An interprofessional research team (2 anesthesiologists, 1 surgeon, an OR nurse, and a social scientist) reviewed videos of 5 intraoperative teams managing a simulated patient who manifested MH while undergoing general anesthesia for an epigastric herniorraphy in a high-fidelity, in situ OR. Participant teams consisted of 2 residents from anesthesiology, 1 from surgery, 1 OR nurse, and 1 certified surgical technician. Teamwork and communication were assessed with 4 published tools: Anesthesiologists' Non-Technical Skills (ANTS), Scrub Practitioners List of Intra-operative Non-Technical Skills (SPLINTS), Non-Technical Skills for Surgeons (NOTSS), and Objective Teamwork Assessment System (OTAS). We developed an evidence-based MH checklist to assess overall patient care. RESULTS: Interrater agreement for teamwork tools was moderate. Average rater agreement was 0.51 For ANTS, 0.67 for SPLINTS, 0.51 for NOTSS, and 0.70 for OTAS. Observer agreement for the MH checklist was high (0.88). Correlations between teamwork and MH checklist were not significant. Teams were different in percent of the MH actions taken (range, 50-91%; P = .006). CONCLUSION: In this pilot study, intraoperative teamwork and communication were not related to overall patient care management. Separating nontechnical and technical skills when teaching OR teamwork is artificial and may even be damaging, because such an approach could produce teams with excellent communication skills as they unsuccessfully manage the patient. OR simulations offer a unique opportunity to research how to best integrate both of these domains to improve patient care.


Assuntos
Comportamento Cooperativo , Herniorrafia/educação , Relações Interprofissionais , Equipe de Assistência ao Paciente , Competência Profissional , Treinamento por Simulação , Lista de Checagem , Fidelidade a Diretrizes , Humanos , Hipertermia Maligna , Projetos Piloto
20.
J Clin Monit Comput ; 29(5): 627-34, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25510959

RESUMO

In this study, we aimed to continuously measure cardiac output (CO) with the electrical velocimetry (EV) method and characterize the hemodynamic profile of patients undergoing spinal anesthesia for elective cesarean delivery (CD), and to discuss the potential benefit of using real time CO monitoring to guide patient management. Forty-two patients scheduled for elective CD under spinal anesthesia were enrolled in this observational study. A non-invasive CO monitor incorporating the electrical velocimetry algorithm, ICON(®) (Cardiotronic(®), La Jolla, California, USA), was used to measure CO and stroke volume (SV) continuously. Peripheral venous pressure was measured intermittently at pre-defined time points. Systemic vascular resistance was calculated retrospectively after completion of the study. Hemodynamic changes at pre-defined time points and caused by phenylephrine administration were analyzed. Hypotension (MAP reduction more than 20% from baseline values) occurred in 71.1% of patients after spinal anesthesia, while the coinstantaneous CO was increased ≥20% from baseline in the majority of patients (76.3%) at the same time. Significant increase in CO took place at 3-2 min before the administration of phenylephrine bolus. Treatment of hypotension with phenylephrine was associated with significant decrease in CO. Continuous CO monitoring with EV enables clinicians to determine CO and SV changes prior to onset of hypotension and to better understand patients' hemodynamics. It is an important addition to the current monitoring. The benefit of routinely using this technique remains to be determined in term of the patient outcomes.


Assuntos
Raquianestesia/métodos , Débito Cardíaco , Cardiografia de Impedância/métodos , Cesárea/métodos , Testes de Função Cardíaca/métodos , Monitorização Intraoperatória/métodos , Adulto , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...