We propose a two-year pilot study to characterize Collective Mindfulness behaviors in NICU and OR teams and to measure their impact on patient safety as measured by the incidence and severity of Non-Routine Events (NREs) during NICU-to-OR handovers and subsequent care. Our Specific Aims are to: 1) Conduct a prospective observational pilot study of NICU and OR teams to estimate the prevalence of perceived CM (i.e., self-reported using the SOS) during neonatal perioperative care; 2) Assess the concordance between expert-rated behavioral markers from the A-V recordings collected during the observational study (exhibited CM) and those teams’ self-reported SOS scores (perceived CM); and 3) Determine the relationship between perceived and/or exhibited CM and the incidence and severity of NREs occurring during neonatal perioperative care. We anticipate that knowledge gained from this study will lay the groundwork for a multi-center study on the impact of team-based HRO interventions on neonatal safety in the perioperative environment.
Determining the decision-making and action strategies used by physicians to detect and manage uncommon but potentially lethal clinical events is critical to improving the “rescue” of patients from such situations. This multicenter study by physicians and experts in cognitive science will use high-fidelity simulations along with rigorous performance assessment and psychological interview methods to identify which decision-making approaches are the most successful and what aspects of the individual clinicians’ training or work processes could be modified to improve outcomes when these events occur during actual patient care. The Specific Aims are to: 1) Develop and test a unified cognitive model and taxonomy of the decision-making strategies clinicians use during critical event management; 2) Create detailed profiles of participants’ clinical practice and simulation experience; 3) Evaluate the factors affecting physicians’ critical event performance; and 4) Evaluate the relationship between simulation-based performance assessment and existing metrics of physician competence (participants’ primary board certification exam scores).
We will partner with surgeons, oncologists, nurses, staff, and adult patients with lung and head or neck cancer recovering from and/or undergoing treatment as outpatients, and their lay caregivers, to more reliably detect and respond more effectively to unexpected clinical deterioration. We will achieve this through three Specific Aims: 1) To create and refine software tools and a predictive model for a surveillance-and-response system to prevent harm from unexpected all-cause clinical deterioration in outpatients receiving cancer treatment; 2) To create and refine processes and training that engage patients and their caregivers as active and reliable participants in detecting and reporting potential clinical deterioration. We will apply high reliability organizational (HRO) principles and theories to develop processes and training for the relevant “team” — the cancer patients, their caregivers, and the clinicians who need to respond to signals from the surveillance system; and 3) To implement in the operational environment and formally evaluate the integrated detection and response tools and processes. We hypothesize (H1) that this system will decrease the likelihood and severity of unexpected treatment events. Further, with the incorporation of a patient/family focused HRO framework, we hypothesize that the system will increase non-routine event reporting (H2) and decrease clinician response time (H3). The resulting tools, methods and predictive model will be scalable to other cancer types as well as being generalizable to other institutions and to other high-risk outpatient populations (e.g., heart failure).
We will conduct a 3-site prospective observational mixed-methods study using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of non-depolarizing neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases. The objectives of this study is to begin to understand: 1) When and why do community anesthesiologists choose to reverse NMB? 2) What are the decision preferences of community anesthesiologists with regard to their decisions to reverse NMB, and what are the clinician and clinical case factors that influence those decisions? and 3) What are the operational knowledge gaps of anesthesia professionals with regard to their ability to follow best-practice evidence for the reversal of NMB?
We propose a comprehensive 4-year study of neonatal patient safety in the perioperative environment to produce the knowledge base required to inform high-impact intervention studies and guide rapid cycle quality improvement. Our Aims are to: 1a) Determine the prevalence and characteristics of NREs during the perioperative care of neonates; 1b) Delineate the relationship(s) between NREs, contributory factors, and surgical mortality and major morbidity during neonatal perioperative care; 2) Perform a comparative analysis of prospective NRE data collection with conventional event reporting methodologies within the same clinical environment; and 4) Collaborate with Primary Children’s Hospital in Salt Lake City, Utah to conduct practical pilot testing of tools and measures refined in Aims 1-3.