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      Patient Handover in Emergency Trauma Situations

      other
      1 , , 2 , 3 , 3 , 4
      ,
      Cureus
      Cureus
      trauma, resident simulation, general trauma surgery, emergency

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          Abstract

          Miscommunication during patient handover can be a major cause of preventable medical errors. Emergency traumas are situations where high stress and cognitive load make communication more difficult. Simulation allows for junior learners to practice emergency scenarios in a low-risk setting. This technical report outlines a simulation involving patient handover in emergency trauma scenarios. The intended group of learners are first-year surgery and emergency medicine residents. The scenarios were developed based on the learning objectives of communication, collaboration, and information transfer. Using a high-fidelity simulation mimicking a tertiary care facility, the skills performed in these scenarios can be applied to everyday practice.

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          Most cited references11

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          Debriefing with good judgment: combining rigorous feedback with genuine inquiry.

          Drawing on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through reflective practice, we develop a model of "debriefing with good judgment." The model specifies a rigorous reflection process that helps trainees surface and resolve pressing clinical and behavioral dilemmas raised by the simulation. Based on the authors' own experience using this approach in approximately 2000 debriefings, it was found that the "debriefing with good judgment" approach often sparks self-reflection and behavior change in trainees.
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            An innovative model for teaching and learning clinical procedures.

            Performing a clinical procedure requires the integration of technical clinical skills with effective communication skills. However, these skills are often taught separately. To explore the feasibility and benefits of a new conceptual model for integrated skills teaching. : Design A qualitative observation and interview-based study of undergraduate medical students. Medical students performed technical and communication skills in realistic clinical scenarios (urinary catherization and wound closure), using latex models connected to simulated patients (SPs). Procedures were observed, videorecorded and assessed by tutors from an adjoining room. Students received immediate feedback from tutors and SPs, before engaging in a process of individual feedback through private review of their videotapes. Group interviews explored the response of students, SPs and tutors. Data were analysed using standard qualitative techniques. Fifty-one undergraduate students were recruited from the Faculty of Medicine, Imperial College, London. The scenarios provided a realistic simulation of two common clinical situations and proved feasible in terms of time, facilities and resources within this institution. Students found the opportunity to integrate communication and technical skills valuable, challenging and an appropriate learning experience. Immediate feedback was especially highly valued. Some students found difficulty integrating technical and communications skills, but benefited from conducting two procedures in the same session. The integrated model was feasible and was perceived to be valuable. Benefits include the opportunity to integrate, within a safe environment, skills which are often taught separately. Promoting reflective practice may enable the successful transfer of these integrated skills to other procedures.
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              Handoffs causing patient harm: a survey of medical and surgical house staff.

              Communication lapses at the time of patient handoffs are believed to be common, and yet the frequency with which patients are harmed as a result of problematic handoffs is unknown. Resident physicians were surveyed about their handoffpractices and the frequency with which they perceive problems with handoffs lead to patient harm. A survey was conducted in 2006 of all resident physicians in internal medicine and general surgery at Massachusetts General Hospital (MGH) concerning the quality and effects of handoffs during their most recent inpatient rotations. Surveys were sent to 238 eligible residents; 161 responses were obtained (response rate, 67.6%). Fifty-nine percent of residents reported that one or more patients had been harmed during their most recent clinical rotation because of problematic handoffs, and 12% reported that this harm had been major. Overall quality of handoffs was reported to be fair or poor by 31% of residents. A minority of residents (26%) reported that handoffs usually or always took place in a quiet setting, and 37% reported that one or more interruptions during the receipt of handoffs occurred either most of the time or always. Although handoffs have long been recognized as potentially hazardous, further scrutiny of handoffs has followed recent reports that handoffs are often marked by missing, incomplete, or inaccurate information and are associated with adverse events. In this study, reports of harm to patients from problematic handoffs were common among residents in internal medicine and general surgery. Many best-practice recommendations for handoffs are not observed, although the extent to which improvement of these practices could reduce patient harm is not known. MGH has recently launched a handoff-safety educational program, along with other interventions designed to improve the safety and effectiveness of handoffs, for its house staff and clinical leadership.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                4 August 2020
                August 2020
                : 12
                : 8
                : e9544
                Affiliations
                [1 ] Medicine, Memorial University of Newfoundland, St. John's, CAN
                [2 ] Anesthesiology, Memorial University of Newfoundland, St. John's, CAN
                [3 ] Surgery, Memorial University of Newfoundland, St. John's, CAN
                [4 ] Health Sciences, Ontario Tech University, Oshawa, CAN
                Author notes
                Article
                10.7759/cureus.9544
                7470670
                b0d916dc-6e73-40b0-85bc-4c628e4f15be
                Copyright © 2020, Peer et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 July 2020
                : 3 August 2020
                Categories
                Medical Simulation
                Trauma

                trauma,resident simulation,general trauma surgery,emergency

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