ABSTRACT
INTRODUCTION: Complex surgical populations are at increased risk of morbidity, especially when experiencing variations in care and poor teamwork. The goal of this project was to improve teamwork and decrease variations in care in a pediatric congenital heart surgery population by implementing Integrated Clinical Pathways (ICPs) on a foundation of teamwork training. METHODS: A core team used project management for completion of the project and measurement of success. The leadership team created a new operations infrastructure for the program to effectively implement and sustain improvement. Master trainers targeting teams caring for the patient population completed teamwork training and coaching. ICPs were designed and implemented using iterative tests of change with the assistance of an expert panel. RESULTS: Three of the 4 units experienced a significant improvement in teamwork after training and coaching. The area without a significant change was one with high-level teamwork training already in place. ICPs were implemented in 2 patient subpopulations. We detected a decrease in total hours intubated using statistical process control charts in both of the ICP patient populations. Despite a decrease in intubation hours, we did not detect a reduction in length of stay in days. The infrastructure for the program was successfully implemented and remains in place 6 years later. CONCLUSIONS: Teamwork can be improved with an efficiently delivered training and coaching program. On a foundation of teamwork, ICPs can be implemented and sustained if a supporting infrastructure is in place including program leadership, buy-in from all teams, project management, and ongoing measurement.
ABSTRACT
We present a case of a premature female infant, with a delayed diagnosis of hemitruncus, who underwent primary repair at 105 days of life. There have been few published reports of premature infants with hemitruncus, and none to our knowledge who underwent repair that was significantly delayed.
Subject(s)
Aorta/abnormalities , Cardiac Surgical Procedures/methods , Infant, Extremely Low Birth Weight , Infant, Premature, Diseases/surgery , Pulmonary Artery/abnormalities , Aorta/diagnostic imaging , Ductus Arteriosus, Patent/surgery , Female , Humans , Infant, Newborn , Infant, Premature , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Time Factors , Ultrasonography , Vascular Surgical ProceduresABSTRACT
BACKGROUND/OBJECTIVES: To develop an online patient education resource for use in spinal cord injury rehabilitation. PARTICIPANTS: The development process involved more than 100 subject-matter experts (SMEs) (rehabilitation professionals and consumers) from across Canada. Preliminary evaluation was conducted with 25 end-users. METHODS: An iterative development process was coordinated by a project team; SMEs (including patients) developed the content in working groups using wiki-based tools. Multiple rounds of feedback based on early prototypes helped improve the courses during development. RESULTS: Five courses were created, each featuring more than 45 minutes of video content and hundreds of media assets. Preliminary evaluation results indicate that users were satisfied by the courses and perceived them to be effective. CONCLUSIONS: This is an effective process for developing multimedia patient education resources; the involvement of patients in all parts of the process was particularly helpful. Future work will focus on implementation, integration into clinical practice and other delivery formats (smart phones, tablets).
Subject(s)
Computer-Assisted Instruction/methods , Internet , Patient Education as Topic/methods , Physical Therapy Modalities , Spinal Cord Injuries/rehabilitation , Feedback , Humans , Patient Satisfaction , Pilot Projects , Program Development , Program Evaluation , User-Computer InterfaceABSTRACT
Lymphatic malformations are developmental anomalies of the lymphatic system that can range in size and symptomatology and are usually diagnosed in early childhood. To follow is a discussion of the proposed etiology, diagnostic methods, and categorization, as well as debated methods of treatment of these malformations.
Subject(s)
Lymphatic Diseases/diagnosis , Lymphatic System/abnormalities , Humans , Lymphatic Diseases/epidemiology , Lymphatic Diseases/therapy , Lymphatic System/embryology , PrognosisABSTRACT
The management of a mastoid subperiosteal abscess has traditionally required mastoidectomy. With the improvement of antibiotic therapy current literature supports the treatment of uncomplicated acute mastoiditis with myringotomy and intravenous antibiotics. Treatment of a mastoid subperiosteal abscess with tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage of the abscess avoids the morbidity and potential complications of mastoid surgery in young children. Three patients diagnosed with a mastoid subperiosteal abscess were managed in this way. The outcome of their treatment has been documented with lengthy otologic follow-up. Complete resolution of the acute infectious process was achieved in all cases with no evidence of recurrent disease.