Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes.

OBJECTIVE: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD: We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS: Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION: Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions.

BACKGROUND: Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of children's death. Trauma care by its very nature is team based but due to the emergent nature of trauma, critical clinical information is often missed in the transition of these patients from one service or unit to another. Teamwork transition technology can help support these transitions and minimize information loss while enhancing information gathering and storage. In this study, we created a large screen technology to support shared situational awareness across multiple clinical roles and departments. OBJECTIVES: This study aimed to examine if the Teamwork Transition Technology (T3) supports teams and team cognition. METHODS: We used a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T3. RESULTS: Results of the evaluation show that most participants agreed that the technology helps achieve the goals set out in the design phase. Respondents thought that T3 organizes and presents information in a different way that was helpful to them. CONCLUSION: In this study, we examined a health IT (T3) that was designed to support teams and team cognition. The results of our evaluation show that participants agreed that T3 does support them in their work and increases their situation awareness.

Care transition of trauma patients: Processes with articulation work before and after handoff.

While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.

Use of Point-of-Care Ultrasound in the Pediatric and Neonatal Emergency Transport Realm.

Point-of-care ultrasound (POCUS) is a tool often used by clinical providers in the care of critically ill or acutely injured patients. POCUS can be used to evaluate for potentially harmful conditions during transport and to optimize downstream management. Although available literature primarily focuses on adults in the prehospital, critical care, and austere environment realm, more literature supporting POCUS use during pediatric and neonatal transport has emerged over the last few years. What is currently available is often from diverse operators and a wide variety of applications. The goal of this article is to describe current pediatric and neonatal POCUS applications and to identify its barriers and limitations in the transport realm. [Pediatr Ann. 2021;50(10):e432-e436.].

Paramedic student encounters with patients during clinical placements: A multi-institutional cohort study.

OBJECTIVE: Paramedic students in the US are required to complete clinical placements to gain supervised experience with real patient encounters. Given wide variation in clinical placement practices, an evidence-based approach is needed to guide programs in setting realistic and attainable goals for students. This study's goal was to describe patient encounters and hours logged by paramedic students during clinical placements. METHODS: A retrospective review of prospectively collected quality assurance data entered by US paramedic students between 2010 and 2014 was conducted. De-identified electronic records entered in the Field Internship Student Data Acquisition Project (FISDAP) Skill Tracker database were included from consenting paramedic students whose records were audited and approved by instructors. Descriptive statistics were calculated. RESULTS: A total of 10,645 students encountered 2,239,027 patients; most encounters occurred in hospital settings (n = 1,311,967, 59%). The median total number of patient encounters per paramedic student was 206 (142-269) and the median total clinical placement hours per student was 626 (504-752). The median number of team leads per student was 56 (30-84). Students encountered a median of 22 (12-31) pediatric patients, ages 0-12 years, and 181 (126-238) adolescent or adult patients. For pediatric patient encounters, the most common clinical impressions were respiratory distress, other medical complaints, and extremity trauma. Among adult patient encounters, the most common clinical impressions included other medical, trauma, and cardiac conditions. CONCLUSIONS: US paramedic students experienced a variable range of patient encounter types and volumes. The findings of this study offer an evidence base from which programs can set realistic and attainable clinical placement requirements.

Prevalence of Unique Pediatric Pathologies Encountered by Paramedic Students Across Age Groups.

UNLABELLED: Introduction Traditionally, Emergency Medical Services (EMS) educators have divided the pediatric population into age groups to assist in targeting their clinical and didactic curriculum. Currently, the accrediting body for paramedic training programs requires student exposure to pediatric patients based entirely on age without specifying exposure to specific pathologies within each age stratification. Identifying which pathologies are most common within the different pediatric age groups would allow educators to design curriculum targeting the most prevalent pathologies in each age group and incorporating the physiologic and psychological developmental milestones commonly seen at that age. Hypothesis It was hypothesized that there are unique clusterings of pathologies, represented by paramedic student primary impressions, that are found in different age groups which can be used to target provider education. METHODS: This is a retrospective review of prospectively collected data documented by paramedic students in the Fisdap (Field Internship Student Data Acquisition Project; Saint Paul, Minnesota USA) database over a one-year period. For the purposes of this study, pediatric patients were defined arbitrarily as those between the ages of 0-16 years. All paramedic student primary impressions recorded in Fisdap for patients aged 0-16 years were abstracted. Primary impression by age was calculated and graphed. The frequency of primary impression was then assessed for significance of trend by age with an alpha ≤.05 considered significant. RESULTS: The following primary impressions showed clinically and statistically significant variability in prevalence among different pediatric age groups: respiratory distress, medical-other, abdominal pain, seizure, overdose/poisoning, behavioral, and cardiac. In patients less than 13 years old, respiratory and other-medical were the most common two primary impressions and both decreased with age. In patients 5-16 years old, the prevalence of abdominal pain and behavioral/psych increased. Bimodal distributions for overdose were seen with one spike in the toddler and another in the adolescent population. Seizures were most common in the age group associated with febrile seizure. Sepsis was seen most often in the youngest patients and its prevalence decreased with age. CONCLUSION: There are statistically significant variations in the frequency of paramedic student primary impressions as a function of age in the pediatric population. Emphasizing paramedic student exposure to the most common pathologies encountered in each age group, in the context of the psychological and physiological milestones of each age, may improve paramedic student pediatric practice. Ernest EV , Brazelton TB , Carhart ED , Studnek JR , Tritt PL , Philip GA , Burnett AM . Prevalence of unique pediatric pathologies encountered by paramedic students across age groups. Prehosp Disaster Med. 2016; 31(4):386-391.

Geographic analysis of traffic injury in Wisconsin: impact on case fatality of distance to level I/II trauma care.

PURPOSE: Traffic injuries are an important public health problem in Wisconsin. This paper examines geographic variations in the incidence and case fatality of traffic injuries, and evaluates proximity to Level I/II trauma care as a predictor of case fatality. METHODS: Data on all persons injured in motor vehicle crashes on Wisconsin roadways during a 10-year period (1992-2001) were obtained from the Wisconsin Crash Outcome Data Evaluation System. Injury rates per 100 million vehicle miles traveled (VMT) and case fatality were visually displayed by county. Multiple logistic regression models were used to evaluate distance between crash site and Level I/II trauma care as a risk factor for fatality, controlling for other factors. RESULTS: During the 10-year period, 50,300 people were severely injured in motor vehicle crashes and 7450 (15%) died. Injury rates per VMT were highest in the southeast counties. In contrast, case-fatality for all injuries and for severe injuries was highest in northern and western counties and significantly associated with distance from Level I/II trauma care after controlling for other predictors of case fatality. CONCLUSIONS: Strategies are needed to reduce the disparity in traffic injury case fatality across the state and to improve outcomes for persons injured in counties distant from Level I/II trauma care.