Littérature scientifique sur le sujet « Emergency Medicine, Trauma, Checklist, Medical Simulation »
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Articles de revues sur le sujet "Emergency Medicine, Trauma, Checklist, Medical Simulation"
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French, J. P., D. Maclean, K. David, A. McCoy, S. Benjamin, J. Fraser, T. Pishe et P. Atkinson. « P049 : Changes in situational awareness of emergency teams in simulated trauma cases using an RSI checklist ». CJEM 20, S1 (mai 2018) : S74. http://dx.doi.org/10.1017/cem.2018.247.
Texte intégralRésumé :
Introduction: Situational awareness (SA) is the team understanding patient stability, presenting illness and future clinical course. Losing SA has been shown to increase safety-critical events in multiple industries. SA can be measured by the previously validated Situational Awareness Global Assessment Tool (SAGAT). Checklists are used in many safety-critical industries to reduce errors of omission and commission. An RSI checklist was developed from case review and published evidence.The New Brunswick Trauma Program supports an inter-professional simulation-based medical education program Methods: Simulations were facilitated in three hospitals in New Brunswick from April 2017 to October 2017. Learner profiles were collected. The SAGAT tool was completed by a research nurse at the end of each scenario. SAGAT scores were non-normally distributed, so results were expressed as medians and interquartile ranges. Mann Whitney U tests were used to calculate statistical significance. To understand the effect of the of an RSI checklist a comparison was made between SAGAT scores at baseline in scenario 1, and the same first scenario completed after a washout period. A Poisson regression analysis will be used to account for the effect of confounding variables in further analyses. Results: The group was composed of Registered Nurses (8), Physicians (7), and Respiratory Therapists (2). Situational awareness increased significantly with the use of an RSI checklist after 1 day of 4 simulations. The washout period ranged between 5 weeks and 8 weeks. The baseline situational awareness of the whole group during scenario 1 was 9 +/− 0.5 (median, IQR), and with the RSI checklist was 12 +/−1 (median, IQR). The difference was highly statistically significant, p=< 0.001. This level of situational awareness using checklist is comparable to the SAGAT scores after 10 scenarios. Conclusion: In this provisional analysis, the use of an RSI checklist was associated with an increase in measured situational awareness. Higher levels of situational awareness are associated with greater patient safety. A Poisson regression model will be used to understand the confounding effects of user expertise and the likely interaction with simulation exposure.
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Pérez-Wulff, Juan, Daniel Márquez, Jesús Veroes, Jonel Di Muro, Carlos Lugo, Rafael Cortés, Susana De Vita, Kenny Araujo, Edinson Valencia et Stefanía Robles. « Listas de chequeo en obstetricia : ayudas cognitivas que salvan vidas ». Revista de Obstetricia y Ginecología de Venezuela 80, no 04 (7 décembre 2020) : 292–302. http://dx.doi.org/10.51288/00800406.
Texte intégralRésumé :
Objective: To propose the use of eight checklists in the country’s obstetric emergency rooms. Methods: An interdisciplinary team was established with physicians specializing in obstetrics and gynecology, perinatology, fetal maternal medicine, critical medicine, anesthesiology, infectology and neonatology. Upon determination of the main pathologies affecting maternal mortality in Venezuela, multiple checklists used in different centers worldwide, publications available in databases and expert opinions were reviewed. They adapted to the realities of the country and medical availability and prioritized medical actions, laboratory tests, drug treatment and diagnostic elements. Results: Checklists for postpartum hemorrhage, obstetric sepsis, hypertensive pregnancy disorders (preeclampsia with signs of severity and eclampsia), magnesium sulfate poisoning, placental acretism, maternal cardiopulmonary resuscitation, and trauma and pregnancy are presented. Conclusion: The checklists resulting from the initiative of the Society of Obstetrics and Gynecology of Venezuela are available to all health personnel who require them for implementation in educational simulation scenarios and in clinical practice, as an additional tool for finding better outcomes in patients who require high complexity management in maternity rooms. Keywords: Checklist, Postpartum hemorrhage, Obstetric sepsis, Hypertensive pregnancy disorders, Magnesium sulfate poisoning, Placental acretism, Maternal cardiopulmonary resuscitation, Trauma and pregnancy
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Binstadt, Emily, Rachel Dahms, Amanda Carlson, Cullen Hegarty et Jessie Nelson. « When the Learner Is the Expert : A Simulation-Based Curriculum for Emergency Medicine Faculty ». Western Journal of Emergency Medicine 21, no 1 (19 décembre 2019) : 141–44. http://dx.doi.org/10.5811/westjem.2019.11.45513.
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Emergency physicians supervise residents performing rare clinical procedures, but they infrequently perform those procedures independently. Simulation offers a forum to practice procedural skills, but simulation labs often target resident learners, and barriers exist to faculty as learners in simulation-based training. Simulation-based curricula focused on improving emergency medicine (EM) faculty’s rare procedure skills were not discovered on review of published literature. Our objective was to create a sustainable, simulation-based faculty education curriculum for rare procedural skills in EM. Between 2012 and 2019, most EM teaching faculty at a single, urban, Level 1 trauma center completed an annual two-hour simulation-based rare procedure lab with small-group learning and guided hands-on instruction, covering 30 different procedural education sessions for faculty learners. A questionnaire administered before and after each session assessed EM faculty physicians’ self-perceived ability to perform these rare procedures. Participants’ self-reported confidence in their performance improved for all procedures, regardless of prior procedural experience. Faculty participation was initially mandatory, but is now voluntary. Diverse strategies were used to address barriers in this learner group including eliciting learner feedback, offering continuing medical education credits, gradual roll-out of checklist assessments, and welcoming expertise of faculty leaders from EM and other specialties and professions. Participants perceived training to be most helpful for the most rarely-encountered clinical procedures. Similar curricula could be implemented with minimal risk at other institutions.
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Lee-Nobbee, P., S. MacGillivray, R. Lam, J. Guilfoyle, A. Mikrogianakis, Y. Lin, V. Grant et A. Cheng. « P090 : The use of a pediatric pre-arrival and pre-departure trauma checklist to improve clinical care in a simulated trauma resuscitation : a randomized trial ». CJEM 20, S1 (mai 2018) : S88—S89. http://dx.doi.org/10.1017/cem.2018.288.
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Introduction: The purpose of this study is to determine if the introduction of a pre-arrival and pre-departure Trauma Checklist as a cognitive aid, coupled with an educational session, will improve clinical performance in a simulated environment. The Trauma Checklist was developed in response to a quality assurance review of high-acuity trauma activations. It focuses on pre-arrival preparation and a pre-departure review prior to patient transfer to diagnostic imaging or the operating room. We conducted a pilot, randomized control trial assessing the impact of the Trauma Checklist on time to critical interventions on a simulated pediatric patient by multidisciplinary teams. Methods: Emergency department teams composed of 2 physicians, 2 nurses and 2 confederate actors were enrolled in our study. In the intervention arm, participants watched a 10-minute educational video modelling the use of the trauma checklist prior to their simulation scenario and were provided a copy of the checklist. Teams participated in a standardized simulation scenario caring for a severely injured adolescent patient with hemorrhagic shock, respiratory failure and increased intracranial pressure. Our primary outcome of interest was time measurement to initiation of key clinical interventions, including intubation, first blood product administration, massive transfusion protocol activation, initiation of hyperosmolar therapy and others. Secondary outcome measures included a Trauma Task Performance score and checklist completion scores. Results: We enrolled 14 multidisciplinary teams (n=56 participants) into our study. There was a statistically significant decrease in median time to initiation of hyperosmolar therapy by teams in the intervention arm compared to the control arm (581 seconds, [509-680] vs. 884 seconds, [588-1144], p=0.03). Time to initiation of other clinical interventions was not statistically significant. There was a trend to higher Trauma Task Performance scores in the intervention group however this did not reach statistical significant (p=0.09). Pre-arrival and pre-departure checklist scores were higher in the intervention group (9.0 [9.0-10.0] vs. 7.0 [6.0-8.0], p=0.17 and 12.0 [11.5-12.0] vs. 7.5 [6.0-8.5], p=0.01). Conclusion: Teams using the Trauma Checklist did not have decreased time to initiation of key clinical interventions except in initiating hyperosmolar therapy. Teams in the intervention arm had statistically significantly higher pre-arrival and pre-departure scores, with a trend to higher Trauma Task Performance scores. Our study was a pilot and recruitment did not achieve the anticipated sample size, thus underpowered. The impact of this checklist should be studied outside tertiary trauma centres, particularly in trainees and community emergency providers, to assess for benefit and further generalizability.
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Amirrafiei, Arash, Seyyed Mahdi Zia Ziabari, Fatemeh Haghshenas-Bakerdar, Ehsan Kazemnejad-Leili et Payman Asadi. « Clinical competencies of emergency medical services paramedics in responding to emergency conditions using Objective Structured Clinical Examination (OSCE) in Guilan ». Journal of Emergency Practice and Trauma 7, no 2 (16 mai 2021) : 101–5. http://dx.doi.org/10.34172/jept.2021.03.
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Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE). Methods: In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests. Results: Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma. Conclusion: Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.
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Forristal, C., K. Hayman, N. Smith, S. Mal, M. Columbus, N. Farooki, S. McLeod, K. Van Aarsen et D. Ouellette. « LO43 : Perceptions of airway checklists and the utility of simulation in their implementation emergency medicine practitioner perspectives ». CJEM 20, S1 (mai 2018) : S21—S22. http://dx.doi.org/10.1017/cem.2018.105.
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Introduction: Checklists used during intubation have been associated with improved patient safety. Since simulation provides an effective and safe learning environment, it is an ideal modality for training practitioners to effectively employ an airway checklist. However, physician attitudes surrounding the utility of both checklists and simulation may impede the implementation process of airway checklists into clinical practice. This study sought to characterize attitudinal factors that may impact the implementation of airway checklists, including perceptions of checklist utility and simulation training. Methods: Emergency medicine (EM) residents and physicians working more than 20 hours/month in an emergency department from two academic centres were invited to participate in a simulated, randomized controlled trial (RCT) featuring three scenarios performed with or without the use of an airway checklist. Following participation in the scenarios, participants completed either a 26-item (control group), or 35-item (checklist group) paper-based survey comprised of multiple-choice, Likert-type, rank-list and open-ended questions exploring their perceptions of the airway checklist (checklist group only) and simulation as a learning modality (all participants). Results: Fifty-four EM practitioners completed the questionnaire. Most control group participants (n=24/25, 96.0%) believed an airway checklist would have been helpful (scored 5/7 or greater) for the scenarios. The majority of checklist group participants (n=29) believed that the checklist was helpful for equipment (27, 93.1%) and patient (26, 89.6%) preparation, and post-intubation care (21, 82.8%), but that the checklist delayed definitive airway management and was not helpful for airway assessment, medication selection, or choosing to perform a surgical airway. This group also believed that using the airway checklist would reduce errors during intubation (27, 93.1%) and that the simulated scenarios were beneficial for adopting the use of the checklist (28, 96.6%). Fifty-three participants (98.1%) believed that simulation is beneficial for continuing medical education and 51 respondents (94.4%) thought that skills learned in this simulation were transferable. Conclusion: EM practitioners participating in a simulation-based RCT of an airway checklist had positive attitudes towards both the utility of airway checklists and simulation as a learning modality. Thus, simulation may be an effective process to train practitioners to use airway checklists prior to clinical implementation.
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Hoopes, Katherine, Tessa Lewitt, Anum Naseem, Anne Messman et Sarkis Kouyoumjian. « Improving Medical School Education on the Care of Sexual Assault Patients : A Quasi-Randomized Controlled Study ». International Journal of Medical Students 9, no 2 (22 juin 2021) : 129–39. http://dx.doi.org/10.5195/ijms.2021.797.
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Introduction: Comprehensive healthcare for survivors of sexual violence is essential to prevent the diverse sequelae associated with the assault. In partnership with a local rape crisis center, we designed an educational module with the goal of training medical students on the basic needs of sexual assault patients with the aim to see if there was a significant difference in preparedness to counsel such patients.
Methods: This quantitative quasi-randomized controlled study tested the effectiveness of an educational module on improving medical student preparedness for encounters with victims of sexual assault. A one-hour presentation, focusing on basic medical and legal knowledge regarding sexual abuse and compassionate patient-centered care, was provided to the intervention group during their compulsory Year 4 Emergency Medicine clerkship orientation. At the end of the month, students in the intervention and control groups were assessed using a standardized patient encounter simulating the presentation of a victim of sexual assault. Scores were determined by standardized patients, who utilized two checklists-one widely used for communication skills (KEECC-A) and the other focusing on sexual assault (WC-SAFE-specific).
Results: For the KEECC-A, there was no significant difference in scores between the control and intervention groups (p=0.9257, 95% Confidence Interval [95%CI] 14.42,15.58]). The WC-SAFE-specific checklists were significantly different between the intervention and control groups (p=0.0076, 95%CI 3.79,4.21).
Conclusion: Our sexual assault module increased preparedness of medical students for encounters with sexual assault victims and provide trauma-informed care.
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Delp, Scott L., Peter Loan, Cagatay Basdogan et Joseph M. Rosen. « Surgical Simulation : An Emerging Technology for Training in Emergency Medicine ». Presence : Teleoperators and Virtual Environments 6, no 2 (avril 1997) : 147–59. http://dx.doi.org/10.1162/pres.1997.6.2.147.
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The current methods of training medical personnel to provide emergency medical care have several important shortcomings. For example, in the training of wound debridement techniques, animal models are used to gain experience treating traumatic injuries. We propose an alternative approach by creating a three-dimensional, interactive computer model of the human body that can be used within a virtual environment to learn and practice wound debridement techniques and Advanced Trauma Life Support (ATLS) procedures. As a first step, we have developed a computer model that represents the anatomy and physiology of a normal and injured lower limb. When visualized and manipulated in a virtual environment, this computer model will reduce the need for animals in the training of trauma management and potentially provide a superior training experience. This article describes the development choices that were made in implementing the preliminary system and the challenges that must be met to create an effective medical training environment.
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Bhoi, Sanjeev, DK Sharma, Sheetal Singh, Sapna Ramani Sardana et Sonia Chauhan. « Code Blue Policy for a Tertiary Care Trauma Hospital in India ». International Journal of Research Foundation of Hospital and Healthcare Administration 3, no 2 (2015) : 114–22. http://dx.doi.org/10.5005/jp-journals-10035-1047.
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ABSTRACT “Code Blue” is generally used to indicate a patient requiring resuscitation or in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. When called overhead, the page takes the form of “Code Blue, (floor), (room)” to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory, any emergency medical professional may respond to a code, but in practice the team makeup is limited to those with advanced cardiac life support or other equivalent resuscitation training. Frequently, these teams are staffed by physicians (from anesthesia and internal medicine in larger medical centers or the emergency physician in smaller ones), respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to “run the code”. This phrase was coined at Bethany Medical Center in Kansas City, Kansas. The term “code” by itself is commonly used by medical professionals as a slang term for this type of emergency, as in “calling a code” or describing a patient in arrest as “coding”.1 The purpose of this study is to make available policy with regard to Code Blue which can be followed in a tertiary care hospitals. It was a descriptive cross-sectional study carried out between January and June 2015. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from public and private hospitals. Checklist was made after an exhaustive review of literature which was then improvised. The checklist was discussed in focused group discussion held on 1 June 2015, and suggestions were incorporated. Validation of the checklist was also done by experts in various private and public hospitals. Subsequently, interaction was done with study population against the backdrop of the checklist and Code Blue policy was formulated. How to cite this article Singh S, Sharma DK, Bhoi S, Sardana SR, Chauhan S. Code Blue Policy for a Tertiary Care Trauma Hospital in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):114-122.
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French, J. P., K. David, S. Benjamin, J. Fraser, J. Mekwan et P. Atkinson. « MP19 : Interprofessional airway microskill checklists facilitate the deliberate practice of direct intubation with a bougie and airway manikins ». CJEM 20, S1 (mai 2018) : S47. http://dx.doi.org/10.1017/cem.2018.173.
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Introduction: Deliberate practice (DP) is the evolution of practice using continually challenging and focused practice on a particular task. DP involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance. Mircroskills training breaks down larger tasks into multiple smaller subtasks and then adds opportunities for feedback and adjustment for each subtask. Microskills training is routinely used to achieve excellence in competitive sports, martial arts, military operations, and music. Endotracheal intubation is a complex task with a clinically significant complication and failure rate. Methods: Two doctors and three nurses developed stepwise team microskills checklist from case review, simulations and published evidence. The checklist was tested, evaluated and developed during four days of simulation faculty team training. The final 36 item checklist was used to facilitate skills training for doctors, nurses, respiratory therapists and ACPs in one level 2, and two level 3 trauma centers from April 2017 to October 2017. The microskills checklist was used in four phases: 1. Group discussion of each microskill step 2. Groups of three team members; operator, assistant and microskill facilitator (using the checklist) to enable the deliberate analysis of the teams current performance. Each subtask is performed with immediate peer and where necessary faculty feedback. Changes are recorded. 3. Total task run though without interruption. Changes are recorded. 4. Repetition and feedback using different team members, manikins, including time pressure. User satisfaction surveys were collected after the skills training session Results: Results. Teams were composed of Registered Nurses (8), Physicians (9), and Respiratory Therapists (2). All of the teams experienced a change in practice. The median number of microskills changed for MDs 13/30, RNs 7/16. The commonest changes in practice were patient positioning (all teams). All professions agreed strongly that the approach produces a positive change in practice (median score 4.8/5). Conclusion: Microskills checklist facilitate endotracheal intubation with a bougie skill development in interprofessional teams in this provisional analysis.
Thèses sur le sujet "Emergency Medicine, Trauma, Checklist, Medical Simulation"
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Stefanone, Valerio Teodoro. « Checklist in Trauma Simulation (CheLTS), a new tool for improving trauma management ». Doctoral thesis, 2022. http://hdl.handle.net/2158/1277020.
Texte intégralRésumé :
Introduction
Trauma is a leading cause of death and disability in the earliest decades of life. Management of major trauma is challenging for emergency physicians due to multiple, simultaneous and potentially fatal lesions. The aim of the present study was to test the effectiveness of a checklist (CL) in improving the management of patients with major trauma.
Methods
We tested our hypothesis in a simulation environment. We included 25 teams, each composed by four Emergency Medicine trainees, in which the most expert was the team leader. We designed four scenarios, focused on the management of trauma. The teams performed all the scenarios in a random sequence. We created a CL with the critical actions to be performed in trauma patients. We gave the CL to the teams alternatively during the first or the last two scenarios. The primary outcomes were the adherence to critical processes of care and the time to critical actions in the scenarios with versus those without the CL. The secondary outcome was the evaluation of non-technical skills.
Results & Discussion
We identified 52 critical actions, which had to be performed during the simulation. In the scenarios performed with the aid of CL, the number of completed actions was significantly higher than in the scenarios without CL (27 ± 9 vs 24 ± 7, p <0.001). By restricting the analysis to critical actions relating to the primary assessment, this result was confirmed again (22 ± 5 vs 19 ± 4, p <0.001). Analyzing the individual actions, in 7 cases they were performed significantly more often in the scenarios performed with the help of the CL: evaluation and treatment of external haemorrhages, evaluation and treatment of back haemorrhages, evaluation and treatment of perineum haemorrhages, removal of all clothes, evaluation of body temperature, immobilization of the cervical spine, evaluation of the neurological status of the four limbs. As regards the timing of execution of critical actions, among the 49 evaluable actions, a significant reduction in time was observed for only 4 items, in favor of scenarios without checklist: objective examination of the chest, positioning of two venous accesses, sample collection for blood count and coagulation, evaluation of the pulses. Non-technical skills were evaluated with the Clinical Teamwork Scale. Global score was significantly higher (95 vs 90, p 0,05) in the simulation performed with the CL vs the simulation performed without. In a high-fidelity simulation environment, the use of a checklist has improved the completeness of management of the patient with major trauma and the non-technical skills of the team in the face of a slowdown in execution. These results suggest that the use of a checklist could lead to a marked improvement in patient safety but that its use, still not widespread in clinical practice, requires specific training. Moreover, further clinical studies should be designed to confirm in the clinical setting this preliminary results obtained in the simulation lab.