Ilya Shekhter

Patient safety begins with proper planning: a quantitative method to improve hospital design

Background A quantitative methodology that enhances design of patient-safe healthcare facilities is presented. The prevailing paradigm of evaluating the design of healthcare facilities relies mainly on postconstruction criticism of design flaws; by then, design flaws may have already negatively affected patient safety. The methodology presented here utilises simulation-based testing in real-size replicas of proposed hospital designs. Other simulations to assess design solutions generated mainly qualitative data about user experience. To assess the methodology, we evaluated one patient safety variable in a proposed hospital patient room. Method Fifty-two physicians who volunteered to participate were randomly assigned to examine a standardised patient in two hospital room settings using a replica of the proposed architectural plan; the two settings differed only by the placement of the alcohol-based hand-rub dispenser. The primary outcome was the hand hygiene compliance rate. Results When the dispenser was in clear view of the physicians as they observed the patient, 53.8% sanitised their hands. When the dispenser was not in their field of view (as in the original architectural plan), 11.5% sanitised their hands (p=0.0011). Based on these results, the final architectural plans were adjusted accordingly. Conclusion The methodology is an effective and relatively inexpensive means to quantitatively evaluate proposed solutions, which can then be implemented to build patient-safe healthcare facilities. It enables actual users to proactively identify patient safety hazards before construction begins.

Establishing a Convention for Acting in Healthcare Simulation Merging Art and Science

Summary Statement Among the most powerful tools available to simulation instructors is a confederate. Although technical and logical realism is dictated by the simulation platform and setting, the quality of role playing by confederates strongly determines psychological or emotional fidelity of simulation. The highest level of realism, however, is achieved when the confederates are properly trained. Theater and acting methodology can provide simulation educators a framework from which to establish an acting convention specific to the discipline of healthcare simulation. This report attempts to examine simulation through the lens of theater arts and represents an opinion on acting in healthcare simulation for both simulation educators and confederates. It aims to refine the practice of simulation by embracing the lessons of the theater community. Although the application of these approaches in healthcare education has been described in the literature, a systematic way of organizing, publicizing, or documenting the acting within healthcare simulation has never been completed. Therefore, we attempt, for the first time, to take on this challenge and create a resource, which infuses theater arts into the practice of healthcare simulation.

A novel educational programme to improve knowledge regarding health care-associated infection and hand hygiene

Lack of hand hygiene by health-care workers is the most significant cause of health care-associated infection. This programme was designed to make health-care workers want to wash their hands, to change their knowledge regarding hand hygiene and health care-associated infection, and influence practice. Improvement between pre- and post-test scores was statistically significant. Compliance is a multifactorial problem that involves knowledge and behaviour. Educational awareness and frequent reminders are critical to maintain high rates of hand hygiene compliance.

A patient safety course for preclinical medical students.

Background:  We developed a course to introduce incoming third‐year medical students to the subject of patient safety, to focus their attention on teamwork and communication, and to create an awareness of patient‐safe practices that will positively impact their performance as clinicians.

Factors impacting hand hygiene compliance among new interns: findings from a mandatory patient safety course.

BACKGROUND Residency is a critical transition during which individuals acquire lifelong behaviors important for professionalism and optimal patient care. One behavior is proper hand hygiene (HH), yet poor compliance with accepted HH practices remains a critical issue in many settings. This study explored the factors affecting hand hygiene compliance (HHC) in a diverse group of interns at the beginning of graduate training. METHODS During a required patient safety course, we observed HH behaviors using a standardized patient encounter. Interns were instructed to perform a focused exam in a simulated inpatient environment with HH products available and clearly visible. Participants were blinded to the HH component of the study. An auditory alert was triggered if participants failed to perform prepatient encounter HH. Compliance rates and the number of alerts were recorded. All encounters were videotaped. RESULTS The HHC among the 169 participants was 37.9% pre-encounter and was higher among female interns than males, although this difference was not statistically significant (41.6% versus 31.5%, P  =  .176). International medical graduates had significantly lower HHC compared with US graduates (23.2% versus 45.1%, P  =  .006). Most initially noncompliant participants performed HH after 1 alert (87.6%). DISCUSSION The initial low rate of HHC in our sample is comparable to other studies. Using direct video surveillance and auditory alarms, we improved our success rates for prepatient encounter HHC. Our study identified medical school origin as an important factor for HHC, and the significantly lower compliance for international medical graduates compared with US graduates has not been previously reported. These findings should be considered in designing interventions such as intern orientation and clinical education programs to improve HH behaviors.

Twitter as a tool to enhance student engagement during an interprofessional patient safety course

Abstract Twitter and other social media forums are gaining popularity in both the academic and conference arenas as tools to increase participant engagement, attention and interaction. While Twitter has been used successfully to engage college students, it has not been explored for use in an interprofessional curriculum. We sought to explore it as a method to foster student engagement. During a weeklong interprofessional patient safety course we invited students and faculty to participate in a Twitter conversation. It was found that this form of social media successfully captured a “behind the scenes” conversation and the experiences of the students which would have not been otherwise captured. This information is guiding future interprofessional educational programming in both the medical and nursing schools.

Man versus machine: The preferred modality

Background:  When learning objectives do not specifically dictate the use of one simulation modality over another, we sought to answer the question of which modality is preferred. We also assessed the impact of debriefing, and the frequency of participants asserting their leadership, as well as self‐reported comfort and competence, and the ability to generate differential diagnoses when either a standardised patient (SP) or high‐technology simulator (HTS) was used.

A comparison of different types of hazardous material respirators available to anesthesiologists.

OBJECTIVE Despite anesthesiology personnel involvement in initial treatment of patients exposed to potentially lethal agents, less than 40 percent of US anesthesiology training programs conduct training to manage these patients.(1) No previous studies have evaluated performance of anesthesiologists wearing protective gear. The authors compared the performance of anesthesiologists intubating a high-fidelity mannequin while wearing either a powered air-purifying respirator (PAPR) or a negative pressure respirator (NPR). METHODS Twenty participants practiced intubations on a high-fidelity simulator until comfortable. Each subject performed 10 repetitions, initially without any gear, then while wearing a protective suit, gloves, and respirator. The order of gear use was randomized and all subjects used both devices. Time for task completion were recorded, and at the end of the trial, subjects were asked to rate their comfort with the equipment. RESULTS After controlling for other variables, overall statistically slower total performance times were observed with use of the PAPR when compared to the control arm and use of the NPR (p 5 0.01 and p < 0.007, respectively). Of the total 90 intubations, only one proved to be esophageal and initially undetected. CONCLUSIONS The use of an NPR or PAPR does not preclude an anesthesiologist from successfully intubating, but practice is necessary. The slightly better performance with the NPR is weighed against the improved comfort of the PAPR and the fact that PAPR users could wear eyeglasses. Neither type of gear allowed the users to auscultate the lung fields to confirm correct endotracheal tube placement.

On the Road with the Simulator

The staff of Jackson Memorial Hospital Patient Safety Center at the University of Miami in Miami Florida, USA, did a road trip. They drove from downtown Miami to Miami Beach (10 minutes, even with traffic). But it was still unforgettable for them. This chapter attempts to draw some lessons out of this journey. Planning is most important. Before embarking on your own simulator road trip, you have to decide what the thing is, i.e., what are your goals and objectives. Why are you doing this simulation? Who is your audience? What is your audience expecting to take away from the simulation? Then next step is, as the chapter demonstrates, to create a scenario that fits into the road trip. The staff narrate in their own words, “We need thinking, instructing, sentient creatures to make the simulation scene come to life. So we plucked the best and brightest from our attending staff. We produced the simulations on a Saturday and Sunday. Each day, we had three attendings. These attendings were familiar with simulation scenarios, the computer that ran the simulators, ‘faking it’ when glitches happened so that the ‘audience’ never perceive the glitches (this is the attribute most essential to any simulator instructor), and debriefing people after the scenario. Each of these instructors had worked with these simulators before and had worked with residents or medical students in a simulator setting. Experience counts.”

Interprofessional Simulation Olympics as a platform to assess team work knowledge acquisition

Introduction Several years ago an on-stage competition called SimWars was introduced to the simulation community. This concept was adopted into a patient safety course as a way to further engage students and named Sim Olympics. We sought to evaluate it as a platform for assessment of learning in students who participated as audience members. Methods A non-equivalent groups design was used to assess whether students could be taught to recognise features of effective teamwork, including a pair of expert raters. One-way repeated measures analysis of variance was used to compare students’ attitudes toward interprofessional education (IPE) education, teamwork and simulation, before and after the course. Results Student scores compared to expert scores showed good agreement. For team 1 there were no statistical differences noted (M=19.58, SD=4.34 given by the students, M=17.50, SD=2.12 given by the experts), t (192)=1.26, p=0.264. There was also no difference for team 2 (M=15.173, SD=5.52 given by the students, M=19.50, SD=3.53 given by the experts), t (173)=0.863, p=0.354. A premeasure and postmeasure of students’ attitudes towards IPE education, teamwork and simulation, also showed significant time effect, p<0.001. Conclusions Medical and nursing students were able to demonstrate their learning of teamwork dynamics by discerning differences between great teamwork and good teamwork as proficiently as seasoned experts. Findings of this study may further support the use of observation as a method to evaluate learning.