2. Improving information transfer
The Centre of Research Excellence in Patient Safety will examine attributes of communication that will either facilitate or produce barriers to delivering safe care. Techniques such as simulation and video taping of clinical encounters will be used in conjunction with human factors engineering concepts as tools to assist in understanding how adverse incidents occur. The use of real-life and simulated situations will test the transition of theory into practice.
Title: Trauma Reception and Resuscitation Project
Principal research category: Improving information transfer
Secondary research category: Data development
Project Coordinator: Mark Fitzgerald
Project aim: This co funded Alfred/Victorian Trauma Foundation project will examine causes of error in trauma resuscitation and will identify strategies to reduce preventable harm.
Project description: Trauma resuscitation has been identified as a specific cause of preventable death with the Emergency Department (ED) accounting for 50% of errors or inadequacies in the care of trauma patients in Victoria.1 2
Studies of trauma resuscitation in Victoria have indicated that there is a need for greater understanding of why delayed and inadequate resuscitation occurs in EDs. The research literature suggests that team composition, team dynamics, knowledge, communication and skill are key contributors to trauma resuscitation success.
The study is being implemented in the Alfred Hospital at the Alfred Hospital, Victoria. Trauma encounters are being videotaped and used to assess the impact of factors such as team dynamic and communication on outcomes. An important component of this study is the development of algorithms to assist clinicians in providing prompt evidence-based treatment for trauma patients.
The use of information technology to make explicit clinical pathways and guidelines is expected to assist in real-time decision-making and improve care delivery.
Project status: Project is in implementation phase. Algorithms developed. IT infrastructure installed.
Contact: Nathan Farrow
References
1. McDermott FT, Cordner SM, Tremayne AB; Road traffic fatalities in Victoria, Australia and changes to the trauma care system. Br J Surg. 2001 Aug;88(8):1099-104.
2. McDermott FT, Rosenfeld JV, Laidlaw JD, Cordner SM, Tremayne AB; Evaluation of management of road trauma survivors with brain injury and neurologic disability in Victoria. J Trauma. 2004 Jan;56(1):137-49.
Title: Communication and Barriers to Safety
Principal research category: Improving information transfer
Project Coordinator: Professor Penny Sanderson
PhD student: TBA
Project aim: This project will identify gaps in coordination and communication and implement strategies to improve collaborative teamwork.
Project description: This project will be undertaken in an acute hospital setting. In this setting care provided to patients is usually delivered by a myriad of specialists. There are multiple handovers and many situations where critical information must be communicated. Unfortunately, there is evidence that this is not always done well. The Quality of Australia Health Care study cited communication failure as the most common cause of preventable disability and death in hospitalized patients.
Information will be gathered using field observations and interviews to identify gaps in coordination and communication. Organisational factors which impact on better outcomes/ performance with regard to effective clinical handover will be evaluated. Clinical handover within professions will be examined horizontally (with peers) and vertically (with Consultants etc), and across professions (between doctors and nurses).
The project will identify whether principles of handover are the same in different areas and the extent to which culture influences handover. A combination of tools, checklists and electronic or computerized systems that avoid the use of memory will be investigated.
Project status: Project is in concept / development stage.
Title: Clinical Handover – Obstetrics and Gynaecology
Principal research category: Improving information transfer
Project Coordinator/s: Professor Peter Cameron, Dr Louise Kornman
PhD student: Dr Georgiana Chin
Project aim: This project will identify the key requirements for effective and safe clinical handover and to develop an intervention to improve the process of clinical handover. Project description: This project will be undertaken in the obstetrics and gynaecology setting and will advance current knowledge of how to effectively improve communication of critical information between staff. While this study will be implemented in the obstetric and gynaecology environment, it is anticipated that the findings will have elements which have general application to other areas of clinical practice. Initially a literature review will be undertaken. A survey of medical and nursing personnel in a major tertiary hospital will be implemented to identify expectation of and barriers to, effective obstetric handover. Direct observation and audit of current practice/incident reports/sentinel events will complement survey findings and will assist researchers in (1) identifying current limitations and (2) developing an effective tool to improve the process. Simulation will be considered as a method of studying/improving clinical handover.
Project status: Project is in implementation phase.
Contact: Georgiana Chin
Managing interruptions and distractions in anaesthesia practice
Principal research category: Improving information transfer
Project Coordinator: Dr Penny Snaderson
PhD student: Tobias Grundeiger
Project aim: In this project we will perform a field study following by a controlled simulator-based study of the impact of interruptions and distractions with a view to recommending processes and/or technology artefacts that may reduce failures of prospective memory.
Project description: There are many interruptions and distractions during the conduct of an anaesthesia list that can cause failures of prospective memory and other adverse consequences for patient safety.
After conducting an introductory literature review we will perform field observations of (1) factors likely to cause failures of prospective memory and (2) work practices and tools that anaesthetists use to buffer themselves against such failures.
A simulator-based study will be designed to examine these factors in a controlled environment. The kinds of interruptions and distractions will be manipulated during the conduct of an anaesthesia list using a range of buffering practices or tools, some of which may have been designed by the experimenters. Results of the study will apply to other areas of healthcare practice.
Project status: Project is in implementation phase.
Contact: Tobias Grundgeiger
Title: An exploration into information gaps in medical and nursing shift handovers in ICU
Principal research category: Improving information transfer
Project Coordinator: Dr Anne Miller
Project aim:This project will define the nature of team coordination in the ICU using Klein’s team coordination framework and to identify where discontinuities in patient care may occur within and between medical and nursing sub-teams.
Project description: Researchers will record both manually and via audio tape-recording all communication events associated with patient care for five critically ill patients for five consecutive days each. In order to record data Research Associate 1 and two research assistants will work in 12 hour shifts located in a convenient position in the cubicle of selected and consenting ICU patients. In this position they will record communication events related to patient care by keeping an electronic journal supplemented by an audio-recording to check the accuracy of notes.
The outcomes of this study are expected to include recommendations for improving care related documentation, team training and changes to coordination processes aimed at reducing discontinuities in care. Additional outcomes will include the extension of theory to teams whose members are distributed over time.
Project status: Project is in implementation phase.
Title: Team Coordination
Principal research category: Improving information transfer
Project Coordinator: Dr Anne Miller
Project description: There is currently a paucity of reliable measures of team coordinatio. This project aims to:
1) gather information using video surveillance of trauma events to identify current practice in regard to team behaviour
2) validate / develope a tool to assess team behaviour usin Klein'sfive stage model of team coordination.
Project status: Project is in analysis phase.
Contact: Stu Marshall
Title: The impact of communication processes and team climate on errors
Principal research category: Improving information transfer
Project Coordinator: Paul Myles
Project aim: The overall aim of this project is to explore the specific, complex relationships involved in inter professional communication and team climate in operating theatres, one in a large tertiary referral hospital and one in a not-for-profit private hospital in metropolitan Melbourne. The specific aims are to:
1) Explore communication processes between team members during patient handover;
2) Identify the contexts within which communication between team members takes place;
3) Analyse communication processes and strategies and decision outcomes for the management to postoperative patients.
Project description:A naturalistic design using field observations and semi-structured interviews is proposed. This study is designed to investigate specific unique characteristics of team communicationin in operating theatres. We will use non participant observation of interactions between operating theatre team members within the postoperative environment in combination with an immediate, comprehensive semi structured, follow-up interview. The desirability of conducting research under natural conditions has been the basis for many discussions on research design. The overall objective is to inform an intervention study to improve communication and improve patient safety in operating theatres
Project status: Project is in implementation phase.
Contact: TBA
Title: Communication in the ICU
Principal research category: Improving information transfer
Project Coordinator: Peter Cameron
Project aim: The aim of this project will be to investigate the impact that length of hours worked has on error.
Project description: Initially hospitals will be categorised according to the length of shift in the Intensive Care Unit. It is proposed that VAED data be used to investigate by hospital group adverse events such as pneumothorax in the Intensive Care Unit. Medical record review will be used to determine validity/time of the event. Following this, experimental work involving simulation will be used to determine effect of working hours on fatigue and error, using the same case scenario.
Contact: Julian Hunt-Smith
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