Improving communication during anaesthesia care transition in the operating room

Jullia, Marion et al. Training in intraoperative handover and display of a checklist improve communication during transfer of care: An interventional cohort study of anaesthesia residents and nurse anaesthetists. European Journal of Anaesthesiology: July 2017 – Volume 34 – Issue 7 – p 471–476

BACKGROUND: Handovers during anaesthesia are common, and failures in communication may lead to morbidity and mortality.

OBJECTIVES: We hypothesised that intraoperative handover training and display of a checklist would improve communication during anaesthesia care transition in the operating room.

DESIGN: Interventional cohort study.

SETTING: Single-centre tertiary care university hospital.

PARTICIPANTS: A total of 204 random observations of handovers between anaesthesia providers (residents and nurse anaesthetists) over a 6-month period in 2016.

INTERVENTION: Two geographically different hospital sites were studied simultaneously (same observations, but no training/checklist at the control site): first a 2-week ‘baseline’ observation period; then handover training and display of checklists in each operating room (at the intervention site only) followed by an ‘immediate’ second and finally a third (3 months later) observation period.

MAIN OUTCOME MEASURES: A 22-item checklist was created by a modified DELPHI method and a checklist score calculated for each handover by adding the individual scores for each item as follows: −1, if error in communicating item; 0, unreported item; 0.5, if partly communicated item; 1, if correctly communicated item.

RESULTS: Before training and display of the checklist, the scores in the interventional and the control groups were similar. There was no improvement in the control group’s scores over the three observation periods. In the interventional group, the mean (95% confidence interval) score increased by 43% [baseline 7.6 (6.7 to 8.4) n = 42; ‘immediate’ 10.9 (9.4 to 12.4) n = 27, P < 0.001]. This improvement persisted at 3 months without an increase in the mean duration of handovers.

CONCLUSION: Intraoperative handover training and display of a checklist in the operating room improved the checklist score for intraoperative transfer of care in anaesthesia.

Full article available at European Journal of Anaesthesiology

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New perioperative QI e-learning resource

The Royal College of Anaesthetists has launched a new online anaesthesia quality improvement (QI) e-learning resource – the Perioperative Improvement Science and Management (PRISM-ed) module

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The PRISM-ed module has been developed by anaesthetists Dr Maria Chazapis, Dr Carolyn Johnston and Dr Ramani Moonesinghe, and written by experts in the field. It builds on the QI web resource funded by UCLH/NIHR Surgical Outcomes and Research Centre (SOuRCe) and the London Academy of Anaesthesia.

The PRISM-ed e-learning module outlines key knowledge and training resources required to deliver quality improvement within healthcare. PRISM-ed is designed to assist with practical implementation through downloadable project toolkits and data templates. Although it is designed for doctors in anaesthetics training, the content is relevant and accessible to anyone in the perioperative multi-disciplinary team or wider health services, who wish to improve the quality of care they provide.

PRISM-ed is being hosted on the e-Learning for Healthcare (e-LfH) online learning hub and can be accessed by all healthcare professionals with an e-LfH account. Completing the PRISM-ed module via the e-LfH online learning platform allows clinicians to record their scores and print a certificate of completion for CPD purposes.

The e-learning module is available here

Rethinking training in airway management

Marshall, S. D. & Chrimes, N. Time for a breath of fresh air: Rethinking training in airway management. Anaesthesia. published online 28 September 2016.

In this editorial, Marshall and Chrimes  suggest that the way in which anaesthetists  conceptualise ‘airway education’ needs to change. They go on to say that while the last two decades of anaesthetic practice have seen a the proliferation of airway devices and techniques, training and maintaining skills in airway management have not necessarily kept pace.

In summary, they write that if anaesthetists are to continue to be regarded as airway management experts, a fundamental shift must occur in both the way they train and retain their skills.

This editorial accompanies an article by Lindkær-Jensen et al., Anaesthesia 2016; 71: doi: 10.1111/anae.13567, A national survey of practical airway training in UK anaesthetic departments. Time for a national policy?

Transforming the learning outcomes of anaesthesiology training into entrustable professional activities: A Delphi study

Wisman-Zwarter, N. et al. European Journal of Anaesthesiology. August 2016. 33 (8) pp. 559–567

Background: True competency-based medical education should produce graduates meeting fixed standards of competence. Current postgraduate programmes are usually based on a pre-determined length of time in training making them poorly suited for an individual approach. The concept of entrustable professional activities (EPAs) enables a more flexible, personalised and less time-dependent approach to training programmes. An EPA is a unit of professional practice, to be entrusted to a trainee to execute without supervision once they demonstrate sufficient competence. As EPAs relate competencies to clinical practice, they structure training and assessment more logically according to the way clinicians actually work. A first step in building an EPA-based curriculum is to identify the core EPAs of the profession.

Objectives: The aim of this study was to identify EPAs for postgraduate training in anaesthesiology and to provide an example of how an existing curriculum can be transformed into an EPA-based curriculum.

Design: A modified Delphi method was used as a consensus approach applying three Delphi rounds.

Setting: Postgraduate specialty training in anaesthesiology in the Netherlands.

Participants: All programme directors in anaesthesiology in the Netherlands except for a single programme director who was involved as a researcher in this study and could not participate.

Main Outcome Measures: Agreement among participants on a list of EPAs. Agreement was specified as a consensus rate of more than 80%.

Results: In this study, 27 programme directors (69% overall response rate) reached consensus on a set of 45 EPAs that describe a curriculum in anaesthesiology for the Netherlands.

Conclusions: This study is a first step toward a more contemporary curriculum in competency-based postgraduate anaesthesiology training.

Read the full abstract here

Using educational video to enhance protocol adherence for medical procedures

Kandler, L. et al. British Journal of  Anaesthesia. 2016. 116 (5): pp.662-669.

Background: Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol.

Methods: We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines.

Results: The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27–0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (allP<0.001).

Conclusions: This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.

Read the abstract here

New and improved RCoA assessor e-learning training tool

From RCoA

‘We are pleased to announce the launch of the new and improved RCoA assessor e-learning training tool, which is designed for selectors directly involved in the Anaesthesia/ACCS selection process.

Additional videos have now been added to expand upon the existing content of the tool. In particular, video content has been added which aims to train selectors to assess the portfolio station effectively by providing demonstrations on how Part 1 and 2 of the station should be conducted and relevantexamples for assessing candidates. Additional content has also been added to provide selectors with practice in assessing the clinical interview for candidates at ST3 level. The videos have been assessed by a panel of expert selectors, to allow users to compare the scores that they provide with the calibrated scores from the expert selectors. Examples of comments made by the expert selectors, which support their score decisions, are also provided. We hope, that by users comparing responses to those provided, this will aid calibration and assist in development as a selector.

As the recruitment process is approaching, we hope that both selectors who are assessing for the first time this year, as well as returning selectors who would like to re-fresh their knowledge on the selection centre and assessing skills, will find the new and improved site useful.

The site can be accessed by the following link: http://www.elearningworkpsychology.com/rcoa/.’

View the full release via RCoA