A 'paperless' wall-mounted surgical safety checklist with migrated leadership can improve compliance and team engagement.

BACKGROUND: Outcome benefits of using the WHO Surgical Safety Checklist rely on compliance with checklist administration. OBJECTIVE: To evaluate engagement of operating room (OR) subteams (anaesthesia, surgery and nursing), and compliance with administering checklist domains (Sign In, Time Out and Sign Out) and checklist items, after introducing a wall-mounted paperless checklist with migration of process leadership (Sign In, Time Out and Sign Out led by anaesthesia, surgery and nursing, respectively). METHODS: This was a pre-post observational study in which 261 checklist domains in 111 operations were observed 2 months after changing the checklist administration paradigm. Compliance with administration of the checklist domains and individual checklist items was recorded, as was the number of OR subteams engaged. Comparison was made with 2013 data from the same OR suite prior to the paradigm change. RESULTS: Data are presented as 2013 versus the present study. The Sign In, Time Out and Sign Out domains were administered in 96% vs 98% (p=0.69), 99% vs 99% (p=1.00) and 22% vs 84% (p<0.001) of cases, respectively. The percentage of relevant checklist items administered in each domain was 60% vs 92%, 84 vs 93% and 80% vs 99%, respectively (p<0.001 for all comparisons). Two-subteam (or better) engagement at Sign In (surgeons usually absent) was 40% vs 94% of cases. Three-subteam (or all staff present) engagement at Time Out and Sign Out was 15% vs 92% and 9% vs 25% of cases, respectively (p<0.001 for all comparisons). CONCLUSIONS: Improvements in team engagement and compliance with administering checklist items followed introduction of migrated leadership of checklist administration and a wall-mounted checklist. This paradigm change was relatively simple and inexpensive.

A behaviourally anchored rating scale for evaluating the use of the WHO surgical safety checklist: development and initial evaluation of the WHOBARS.

BACKGROUND: Realising the full potential of the WHO Surgical Safety Checklist (SSC) to reduce perioperative harm requires the constructive engagement of all operating room (OR) team members during its administration. To facilitate research on SSC implementation, a valid and reliable instrument is needed for measuring OR team behaviours during its administration. We developed a behaviourally anchored rating scale (BARS) for this purpose. METHODS: We used a modified Delphi process, involving 16 subject matter experts, to compile a BARS with behavioural domains applicable to all three phases of the SSC. We evaluated the instrument in 80 adult OR cases and 30 simulated cases using two medical student raters and seven expert raters, respectively. Intraclass correlation coefficients were calculated to assess inter-rater reliability. Internal consistency and instrument discrimination were explored. Sample size estimates for potential study designs using the instrument were calculated. RESULTS: The Delphi process resulted in a BARS instrument (the WHOBARS) with five behavioural domains. Intraclass correlation coefficients calculated from the OR cases exceeded 0.80 for 80% of the instrument's domains across the SSC phases. The WHOBARS showed high internal consistency across the three phases of the SSC and ability to discriminate among surgical cases in both clinical and simulated settings. Fewer than 20 cases per group would be required to show a difference of 1 point between groups in studies of the SSC, where α=0.05 and ß=0.8. CONCLUSION: We have developed a generic instrument for comprehensively rating the administration of the SSC and informing initiatives to realise its full potential. We have provided data supporting its capacity for discrimination, internal consistency and inter-rater reliability. Further psychometric evaluation is warranted.

Expressing concern and writing it down: an experimental study investigating transfer of information at nursing handover.

AIMS: To examine the effects of two factors on the transmission of clinical information at nursing handover. These factors were: (i) an affective statement expressing concern about the information; and (ii) verbal reference to a written summary of the information. BACKGROUND: Quality of communication at patient handover is inconsistent, compromising patient safety. Little is known about the nuances of communication that lead to effective handovers. Furthermore, effective information transmission during handovers is seldom evaluated using experimental research designs. DESIGN: A randomized, single-blind, controlled experiment. METHODS: Postanaesthesia care unit or surgical ward nurses and final-year nursing students were randomly assigned to watch one of four versions of a video-recorded handover. In each version, one piece of information was presented as either a simple statement (control), with an affective qualifier, with a written summary of the information, or with both an affective qualifier and a written summary. Primary outcome was assessed by questionnaire following a task directing attention away from the handover. Data were collected July-October, 2013 and analysed using 2 × 2 anova. RESULTS: A total of 157 nurses participated. Successful transmission of the clinical information did not significantly differ across the experimental conditions. Subgroup analysis revealed significantly higher transmission success among more experienced nurses when the affective statement was present compared to when it was absent (Kruskal-Wallis P = 0·002). CONCLUSIONS: Expressing concern about information or directing attention to written notes may not improve information transfer at handover. However, affective qualifiers may have differential receiver-specific influences on information retention.

Is refractory angina pectoris a form of chronic pain? A comparison of two patient groups receiving spinal cord stimulation therapy.

AIM: To compare psychological and pain-related characteristics of patients with chronic pain and patients with refractory angina pectoris who had been treated with spinal cord stimulation (SCS) therapy. METHOD: Twenty-four patients receiving SCS therapy were interviewed. Four psychological variables were assessed using standardised questionnaires for pain catastrophising, health locus of control, anxiety sensitivity, and self-efficacy. Patients also completed the revised version of the Short-Form McGill Pain Questionnaire, the Short-Form Health Survey, and self-reported measures of global perceived effect, pain, functionality, and satisfaction with SCS therapy. RESULTS: Most patients reported improvements in pain, functionality, and improvement overall. Some health locus of control dimensions were significantly higher for the angina group than the chronic pain group, and chronic angina patients reported significantly lower levels of intermittent pain. Virtually all patients reported being satisfied with SCS therapy. CONCLUSION: Most self-rated psychological and pain-related characteristics were no different between the two groups, which gives some support to the view that refractory angina is a form of chronic pain. The results also add to evidence supporting the use of SCS therapy for refractory angina pectoris; however, differences observed on a few variables may indicate points of focus for the assessment and treatment of such patients.

Seeing what's happening on the inside: patients' views of the value of diagnostic cardiac computed tomography angiography.

OBJECTIVES: Cardiac computed tomography angiography (CCTA) is a commonly used diagnostic test for coronary artery disease. Despite its considerable clinical value, few studies have explored the psychological value of CCTA from the perspective of patients undergoing testing. This study aimed to investigate the patient-perceived value of diagnostic CCTA testing, specifically in relation to patients' perceptions of their heart health and health behaviours. DESIGN: The study used a qualitative methodology incorporating thematic analysis before and after testing. METHODS: Semi-structured interviews were conducted before and after the receipt of CCTA test results among 13 non-acute patients attending a heart clinic in New Zealand for diagnostic CCTA. Data analysis followed a thematic analysis approach applied at each interview time point. RESULTS: Three themes were identified from the pre-diagnostic interviews: expectations that testing would facilitate heart-related understanding; the role of CCTA as an essential requirement for considering the use of cardiac medication; and awareness of the importance of heart-healthy behaviours. Post-diagnostic interview analysis identified four themes: positive psychological responses to cardiac diagnosis; perceived value of viewing scan images; the potential impact of testing on health behaviour intentions; and patients' reflections on the procedure. CONCLUSIONS: These results suggest that CCTA has the potential to meet knowledge-gaining expectations that patients bring to clinic and may increase motivation of health-protective behaviours. Diagnostic CCTA may therefore provide an ideal opportunity to address patients' illness understanding and behavioural intentions. The effective utilization of scan images as a supplement to consultation may enhance such practice objectives and warrants further investigation. STATEMENT OF CONTRIBUTION: What is already known on this subject? Cardiac computed tomography angiography (CCTA) is an advanced diagnostic test that is particularly useful for early diagnosis of coronary artery disease. Cardiac computed tomography angiography is able to produce highly detailed images of the formation and build-up of calcium deposits in coronary vasculature, thus providing a window into an otherwise unseen disease process. Although CCTA is increasingly utilized by clinicians, little is known about its psychological value for cardiac patients undergoing the test. What does this study add? Cardiac computed tomography angiography testing can be a potentially important experience for cardiac patients in understanding their cardiac health. Cardiac computed tomography angiography could provide an opportune time to address patients' health behaviour intentions and treatment beliefs. Effective utilization of CCTA scan images in consultation may help to enhance consultation objectives.

Doctors' willingness to give honest answers about end-of-life practices: a cross-sectional study.

OBJECTIVES: We aimed to (1) evaluate the extent to which doctors in New Zealand would be willing to answer honestly questions about their care of patients at the end of their lives and (2) identify the assurances that would encourage this. Results were compared with findings from a previous pilot study from the UK. DESIGN: Survey study involving a mailed questionnaire. SETTING: New Zealand hospital and community-based medical care settings. PARTICIPANTS: The questionnaire was mailed to a random sample of 800 doctors in New Zealand who were vocationally registered with the Medical Council of New Zealand in disciplines involving caring for patients at the end of their lives. PRIMARY AND SECONDARY OUTCOME MEASURES: Willingness to provide honest answers about various aspects of end-of-life care; assurances that might increase willingness to provide honest answers to questions about end-of-life practices. RESULTS: Completed questionnaires were returned by 436 doctors. The majority of respondents (59.9-91.5%) indicated willingness to provide honest answers to such questions. However, more than a third of doctors were unwilling to give honest answers to certain questions regarding euthanasia. These results are comparable with the UK data. Complete anonymity was the assurance most likely to encourage honest answering, with most of the respondents preferring the use of anonymous written replies. Respondents were less reassured by survey endorsements from regulatory bodies. Themes in free comments included the deterrent effect of medicolegal consequences, fear of censure from society, peers and the media and concerns about the motivations and potential uses of such research. CONCLUSIONS: Many New Zealand doctors were willing to give honest answers to questions about end-of-life practices, particularly if anonymity was guaranteed; others, however, expressed doubts or indicated that they would not be willing to provide honest answers to questions of this sort.

The psychological impact of test results following diagnostic coronary CT angiography.

OBJECTIVE: Coronary computed tomography (CT) angiography is an advanced cardiac imaging test commonly used for diagnosing early signs of ischemic heart disease. Despite its importance in cardiology, little is known about its psychological effect on patients. The present study sought to examine these effects in relation to illness perceptions, cardiac health behavior intentions, and subsequent health behaviors. METHODS: Forty-five nonacute cardiac patients who were referred for diagnostic coronary CT angiography completed questionnaires prior to testing and following the receipt of test results, at which point illness perceptions and intentions to take cardiac medication, as well as diet and exercise intentions were measured. Exercise and dietary behaviors were measured at follow-up 6 weeks later. Changes on these variables were then compared between patients diagnosed with normal arteries and patients diagnosed with diseased arteries. RESULTS: Compared to positive-testing patients, patients with normal test results reported significant changes toward more positive illness perceptions following testing, with improvements in emotional effect of illness, illness concern, consequences, and personal control of illness. The illness perception of treatment control was seen as more important among positive-testing patients, whereas both groups reported increases in illness coherence. Health behavior intentions (cardiac medication intentions and exercise intentions) increased for positive-testing patients only, as did physical activity at follow-up. CONCLUSIONS: Diagnosis-dependent psychological effects can be detected following coronary CT angiography. These effects have important implications for patient health and health care in diagnostic contexts, and the results from this study can be used to guide further research in this area.

Psychological responses to cardiac diagnosis: changes in illness representations immediately following coronary angiography.

OBJECTIVE: Coronary angiography is a commonly used diagnostic test for ischemic heart disease. Little is known, however, about how undergoing the procedure impacts on the ways in which individuals perceive their illness. We sought to explore patients' reactions to an angiogram in terms of changes in symptom appraisal, perceived consequences of their condition, and patients' illness concern and emotional response to their condition after the receiving diagnostic results. METHODS: The Brief IPQ was administered to patients undergoing a diagnostic coronary angiogram (N=57) before and immediately following the procedure. Changes in illness representations were then compared between patients diagnosed with diseased arteries and patients with normal arteries. RESULTS: We found that the number of symptoms patients associated with their condition, illness consequences, and illness emotion decreased for patients receiving normal results but remained unchanged for patients receiving results showing diseased arteries. Illness concern decreased significantly for both patient groups. CONCLUSIONS: The results demonstrate that diagnostic results can have clear and immediate effects on how patients' view and emotionally respond to their symptoms. The results also suggest that patients cognitively prepare themselves to receive an unfavorable diagnosis and the pattern suggests those receiving normal results modify their perceptions in a positive direction rather than those receiving an unfavorable diagnosis.

The role of illness perceptions in patients with medical conditions.

PURPOSE OF REVIEW: In this article we summarize recent investigations into the influence of illness perceptions on outcomes in patients with medical conditions. RECENT FINDINGS: Developments in assessment include the publishing of a new brief scale to assess illness perceptions and the examination of the relationship between patient drawings of their illness and outcomes. Recent studies in primary care highlight the importance of patients' beliefs and emotional responses to their illness as being important in influencing their satisfaction with the consultation, reassurance following negative medical testing and future healthcare use. Recent research shows illness perceptions to have associations with a number of outcomes in chronic illness including self-management behaviours and quality of life. As yet, however, few interventions have been developed designed to change illness perceptions and improve illness outcomes. Emerging areas of research include the application of illness perceptions to mental illness and genetic and risk factor testing. SUMMARY: Research on illness perceptions has confirmed that patients' beliefs are associated with important outcomes in a broadening range of illnesses and risk factor testing. New interventions based on this model have the potential to improve patient outcomes but have yet to be widely developed and applied.

You eat what you are: modern health worries and the acceptance of natural and synthetic additives in functional foods.

There is an increasing array of functional foods available that are designed to confer health benefits. However, individuals' worries about new technology and modernity may influence the acceptance of these products. In this study, we investigated how modern health worries influence attitudes and decisions about functional foods. We asked participants (n=390) to rate pictures of products with either added vitamins or added scientific compounds. Each product shown purported to have one of three possible targeted effects: to reduce the likelihood of a disease, to reduce a risk factor associated with a disease, or to improve personal appearance. We found levels of modern health worries to be significantly associated with participants' reports of organic food consumption and presence of food allergies. Modern health worries were also significantly related to a preference for foods with natural as opposed to synthetic additives. Participants with higher levels of modern health worries had a greater acceptance of functional foods designed to reduce the likelihood of disease compared to participants with low modern health worries. Overall, the results suggested that modern health worries are an important psychological factor to consider with regards to attitudes toward functional foods.