Latent Safety Threats and Countermeasures in the Operating Theater: A National In Situ Simulation-Based Observational Study.

INTRODUCTION: In situ simulation provides a valuable opportunity to identify latent safety threats (LSTs) in real clinical environments. Using a national simulation program, we explored latent safety threats (LSTs) identified during in situ multidisciplinary simulation-based training in operating theaters in hospitals across New Zealand. METHOD: Surgical simulations lasting between 15 and 45 minutes each were run as part of a team training course delivered in 21 hospitals in New Zealand. After surgical in situ simulations, instructors used a template to record identified LSTs in a postcourse report. We analyzed these reports using the contributory factors framework from the London Protocol to categorize LSTs. RESULTS: Of 103 postcourse reports across 21 hospitals, 77 contained LSTs ranging across all factors in the London Protocol. Common threats included staff knowledge and skills in emergencies, team factors, factors related to task or technology, and work environment threats. Team factors were also commonly reported as protecting against adverse events, in particular, creating a shared mental model. Examples of actions taken to address threats included replacing or repairing faulty equipment, clarifying emergency processes, correcting written information, and staff training for clinical emergencies. CONCLUSIONS: The pervasiveness of LSTs suggests that our results have widespread relevance to surgical departments throughout New Zealand and elsewhere and that collective solutions would be valuable. In situ simulation is an effective mechanism both for identifying threats to patient safety and to prompt initiatives for improvement, supporting the use of in situ simulation in the quality improvement cycle in healthcare.

Sustaining multidisciplinary team training in New Zealand hospitals: a qualitative study of a national simulation-based initiative.

AIM: Healthcare is delivered by teams, but the training of healthcare staff is commonly undertaken in professional silos. This study investigated local perspectives on the sustainability of NetworkZ, a New Zealand national simulation-based multi-disciplinary operating room team training programme. METHOD: Local course instructors and managers were invited to participate in semi-structured interviews. Diffusion of innovations theory was utilised to frame deductive thematic analysis of interview data. RESULTS: Twenty-seven people participated. Interviewees described valuing NetworkZ for its multi-disciplinary orientation, in-situ delivery, scenario realism, relevance to teamwork and communication and potential for generalisability to other settings. Interviewees also identified NetworkZ as generating improvements in teamwork and crisis management. NetworkZ was described as complex, due to multidisciplinary participation and the multiple roles and skillsets of instructors needed to run simulations smoothly, making the programme resource intensive to deliver. CONCLUSION: NetworkZ is appreciated as a valuable and unique programme for developing important teamwork and communication skills. Its sustainability is dependent on adequate resourcing and funding.

Challenging gender stereotypes and advancing inclusive leadership in the operating theatre.

Modern healthcare is delivered by interprofessional teams, and good leadership of these teams is integral to safe patient care. Good leadership in the operating theatre has traditionally been considered as authoritative, confident and directive, and stereotypically associated with men. We argue that this may not be the best model for team-based patient care and promote the concept of inclusive leadership as a valid alternative. Inclusive leadership encourages all team members to contribute to decision-making, thus engendering more team cohesion, information sharing and speaking up, and ultimately enhancing team effectiveness. However, the relational behaviours associated with inclusive leadership are stereotypically associated with women and may not in fact be recognised as leadership. In this article we provide evidence on the advantages of inclusive leadership over authoritative leadership and explore gender stereotypes and obstacles that limit the recognition of inclusive leadership. We propose that operating teams rise above gender stereotypes of leadership. Inclusive leadership can elicit maximum performance of every team member, thus realising the full potential of interprofessional healthcare teams to provide the best care for patients.

Orienteers with poor colour vision require more than cunning running.

BACKGROUND: Highly detailed colour coded maps are used in the sport of orienteering to enable competitors to navigate from one check point to another and to provide guidance on the nature of the terrain to be traversed. The colours are defined by the International Orienteering Foundation (IOF) and are said to have been chosen so they will not be confused by competitors who have abnormal colour vision. However, there are anecdotal reports that individuals with colour vision defects do have problems with the colour coding. METHOD: A Minolta Spectrophotometer CM-503i was used to measure the CIE x,y chromaticity co-ordinates and the reflectances of the standard colours recommended by the IOF for the colour coding of orienteering maps, as well as the colours on two maps used in orienteering events. RESULTS: Four pairs of IOF standard colours are likely to be confused by protan observers and four pairs by deutan observers. There were three pairs of colours likely to be confused by both deutan and protan observers on one of the competition maps and one pair likely to be confused by protan observers on the other map. Some of the colours on the actual competition maps differed noticeably from the standard IOF colours. DISCUSSION: Orienteers with more severe forms of abnormal colour vision are likely to be disadvantaged by their inability to differentiate some colours used on orienteering maps. The IOF should choose different colours that are less likely to be confused or should employ a redundant code (such as a pattern or texture). There is need for better quality control of the colours of competition maps to ensure they do conform to the IOF standard colours.

Intraperitoneal delivery of exogenous corticosterone via osmotic pump in a passerine bird.

Selecting the most reliable method to deliver exogenous steroids remains a problem for researchers, particularly when designing experiments on small birds. We used intraperitoneal (IP) osmotic pumps to deliver exogenous corticosterone (CORT) and RU486 in captive White-throated Sparrows. Males received implants containing either a low (LD) or moderate dose (MD) of CORT, RU486 (RU), or polyethylene glycol vehicle only (V). This method provided sustained elevations in baseline CORT in both LD and MD males compared to V males, with higher CORT levels induced in MD males. Slight increases in post-implant CORT resulted in V males, but not in RU males. We observed no significant change in the condition of V males in terms of body mass, furcular fat score or food intake rates, although locomotor activity declined slightly after implantation. Taken together, our results suggest that IP pumps had little impact on the overall health of the birds. CORT levels were maintained within natural ranges for this species, suggesting that our results are biologically relevant and useful for future endocrine studies with small birds.

Viscoelasticity of pediatric blood and its implications for the testing of a pulsatile pediatric blood pump.

Red blood cell hematocrit, aggregation and deformability, and plasma protein concentration influence the viscosity and elasticity of whole blood. These parameters affect the flow properties, especially at low shear rates (< 50 s(-1)). In particular, we have previously shown that the viscoelasticity of fluid affects the inlet filling characteristics and regions of flow separation in small pulsatile blood pumps. Although the viscosity of pediatric blood has been thoroughly studied, its elasticity has not been previously measured. Here we present the viscosity and elasticity of pediatric blood against shear rate for hematocrits from 19-56, measured using an oscillatory rheometer. There is little effect of patient age on blood viscoelasticity. A statistical analysis showed that when compared at constant hematocrit, blood from adult and pediatric patients had similar viscoelastic properties. We present blood analog solutions, as a function of hematocrit, constructed on the basis of the pediatric measurements. Flow field results for viscoelastic analogs of 20, 40 and 60% hematocrit and a Newtonian analog will be compared in the initial, in vitro testing of the Penn State pediatric blood pump, to determine the importance of incorporating a viscoelastic analog into the desigh interaction.