Ellen M. Justice

Bedside Shift-to-shift Handoffs: A Systematic Review of the Literature

Multiple institutions identify communication and shift-to-shift handoffs as a source of clinical errors. Conducting handoffs at the bedside has been proposed as a potential solution to improve the quality of communication at change of shift. This article reports a systematic review of English-language research articles, published between January 1, 2008, and October 31, 2014, focused on bedside shift-to-shift handoffs. Forty-one articles were identified and analyzed in this systematic review.

The development of a validated checklist for thoracentesis: preliminary results.

Thoracentesis is an invasive procedure known to result in complications. Procedure skills should be taught and evaluated more effectively to improve health care quality. Validated checklists are central to teaching and assessing procedural skills. The results of the first step of the validation of a thoracentesis checklist are described. A comprehensive literature review of articles published on thoracentesis did not yield a validated checklist. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a thoracentesis checklist. The internal consistency coefficient using Cronbach’s α was .94. Developing the 23-item thoracentesis checklist for teaching and assessing thoracentesis is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

Shift-to-Shift Handoff Effects on Patient Safety and Outcomes: A Systematic Review

Multiple health care organizations have identified handoffs as a source of clinical errors; however, few studies have linked handoff interventions to improved patient outcomes. This systematic review of English-language research articles, published January 2008 to May 2015 and focusing on shift-to-shift handoff interventions and patient outcomes, yielded 10 774 unique articles. Twenty-one articles met inclusion criteria, measuring each of the following: patient falls (n = 7), reportable events (n = 6), length of stay (n = 4), mortality (n = 4), code calls (n = 4), medication errors (n = 4), medical errors (n = 3), procedural complications (n = 2), pressure ulcers (n = 2), weekend discharges (n = 2), and nosocomial infections (n = 2). One study each also measured time to first intervention, restraint use, overnight transfusions, and out-of-hours deteriorations. Studies that reported funding had higher quality scores. It is difficult to identify trends in the handoff research because of simultaneous implementation of multiple interventions and heterogeneity of the interventions, outcomes measured, and settings. The authors call for increased handoff research funding, especially for studies that include patient outcome measures.

Structure and outcomes of interdisciplinary rounds in hospitalized medicine patients: A systematic review and suggested taxonomy

BACKGROUND Interdisciplinary rounds (IDR) have been described to improve outcomes. However, there is limited understanding of optimal IDR design. PURPOSE To systematically review published reports of IDR to catalog types of IDR and outcomes, and assess the influence of IDR design on outcomes. DATA SOURCES Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Journals Ovid, Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), and PubMed from 1990 through December 2014, and hand searching of article bibliographies. STUDY SELECTION Experimental, quasiexperimental, and observation studies in English-language literature where physicians rounded with another healthcare professional in inpatient medicine units. DATA EXTRACTION Studies were abstracted for study setting and characteristics, and design and outcomes of IDR. DATA SYNTHESIS Twenty-two studies were included in the qualitative analysis. Many were of low to medium quality with few high-quality studies. There is no clear definition of IDR in the literature. There was wide variation in IDR design and team composition across studies. We found three different models of IDR: pharmacist focused, bedside rounding, and interdisciplinary team rounding. There are reasonable data to support an association with length of stay and staff satisfaction but little data on patient safety or satisfaction. Positive outcomes may be related to particular components of IDR design, but the relationship between design and outcomes remains unclear. CONCLUSIONS Future studies should be more deliberately designed and fully reported with careful attention to team composition and features of IDR and their impact on selected outcomes. We present a proposed IDR definition and taxonomy for future studies. Journal of Hospital Medicine 2016;11:513-523.

The Development of a Validated Checklist for Adult Lumbar Puncture Preliminary Results

Lumbar puncture (LP) is known to result in complications. Procedure skills should be taught and evaluated more effectively to improve health care quality. Validated checklists are central to teaching and assessing procedural skills. The results of the first step of the validation of an adult LP checklist are described. A comprehensive literature review of articles published on LP did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 experts, was used to develop a 20-item LP checklist for teaching and assessing LP, the first step in the validation process. The internal consistency coefficient using Cronbach’s αwas 0.79. The authors used a modified Delphi method to develop a checklist for teaching and assessing LP. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

Conducting a successful systematic review of the literature, part 1.

Understanding literature reviews Systematic reviews of the literature have replaced expert commentaries and narrative reviews as the gold standard for summarizing the evidence found in research literature.1 Expert commentaries or narrative reviews may display the biases of the authors. In contrast, systematic reviews use explicit, rigorous methods to identify all relevant articles, critically appraise the articles, and synthesize the evidence. Following this rigorous process helps minimize bias and improve the reliability and accuracy of the conclusions. This makes it easier for healthcare professionals to trust the evidence presented, apply it to patient care, and write clinical practice guidelines. According to a 2011 Institute of Medicine report, today’s healthcare decision makers rely on systematic reviews to inform clinical decisions.2 Well-conducted systematic reviews “identify, select, assess, and synthesize” the evidence that makes clear what’s known and not known about drugs, devices, education and training methods, and healthcare practices.2 As noted by Hemingway and Brereton,1 a systematic review of the literature is aimed at • identifying all relevant evidence • assessing the quality of each study or report • synthesizing the findings from individual studies or reports in an unbiased manner • interpreting the findings and presenting a balanced and impartial summary of the findings, with adequate consideration of any flaws. Conducting a systematic review can be arduous and time-consuming, but done correctly, it can answer important questions and increase our understanding of a topic. All systematic reviews should start with a peer-reviewed protocol (or plan),1,3 which will be described in more detail later. The protocol will allow for future replication and transparency of the methods used, increasing the chances of publication. A qualitative systematic review summarizes primary studies but doesn’t combine the study results using statistical methods. A systematic review that uses quantitative statistical methods to combine the results of two or more primary studies is called a meta-analysis.4 A mixed-method systematic review includes both qualitative and quantitative data in the final manuscript.1 In this article, we describe the first 5 of the 10 steps of conducting a qualitative systematic review that follows the latest guidelines, including the Institute of Medicine standards2 and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.5 (See 10 steps to a systematic review.)

The Development of a Validated Checklist for Radial Arterial Line Placement Preliminary Results

Radial arterial line placement is an invasive procedure that may result in complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a radial arterial line placement checklist are described. A comprehensive literature review of articles published on radial arterial line placement did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 interdisciplinary, interinstitutional experts, was used to develop a radial arterial line placement checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 22-item checklist for teaching and assessing radial arterial line placement is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

The development of a validated checklist for paracentesis: preliminary results.

Paracentesis is an invasive procedure known to result in complications. Procedure skills should be taught and evaluated more effectively to improve health care quality. Validated checklists are central to teaching and assessing procedural skills. The results of the first step of the validation of a paracentesis checklist are described. A comprehensive literature review of articles published on paracentesis did not yield a validated checklist. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a paracentesis checklist. The internal consistency coefficient using Cronbach’s α was .92. Developing the 24-item paracentesis checklist for teaching and assessing paracentesis is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

The Development of a Validated Checklist for Nasogastric Tube Insertion: Preliminary Results

Nasogastric (NG) tube insertion is known to result in complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of an NG tube insertion checklist are described. A comprehensive literature review of articles published on NG tube insertion did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 interdisciplinary, interinstitutional experts, was used to develop an NG tube insertion checklist. The internal consistency coefficient using Cronbach’s α was .80. Developing a 19-item checklist for teaching and assessing NG tube insertion is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

The Development of a Validated Checklist for Femoral Venous Catheterization Preliminary Results

Femoral venous catheterization is a common, invasive procedure, which may lead to serious complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a femoral venous catheterization checklist are described. A comprehensive literature review of articles published on femoral venous catheterization did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a femoral venous catheterization checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 29-item checklist for teaching and assessing femoral venous catheterization is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.