Developing a post-discharge suicide prevention intervention for children and young people: a qualitative study of integrating the lived-experience of young people, their carers, and mental health clinicians.

BACKGROUND: Suicide in young people is a leading cause of death. Interventions that are reflexive, tailored, and developed in concert with this at-risk population are needed. This study aimed to integrate lived-experience into the design of a suicide prevention intervention delivered by phone to young people post-discharge from an emergency department (ED) for suicide risk or self-harm. METHODS: Qualitative study was conducted at the Queensland Children's Hospital, Brisbane Australia. Four focus groups with young people with lived-experience, parents or carers and ED mental health clinicals were conducted. In total 5 young people with lived-experience of suicidality (17-21 years, Mage = 19.20), 3 parents and carers with a lived-experience of caring for a young person with mental illness, and 10 ED mental health clinicians participated in focus groups. The first phase of qualitative analysis involved a phenomenological analysis and second phase included a deductive content analysis. The paper is following the Consolidated Criteria for Reporting Qualitative Research. RESULTS: First phase, a phenomenological analysis identified three foundational themes to structure future follow-up phone interventions: a person-centred focus, the phone-call dynamic, and the phone-call purpose. Second phase, a deductive content analysis found that participants preferred an intervention that was structured, consistent, and finite. Moreover, an intervention that was authentic, able to facilitate and empower growing independence, and achievable of young people after an ED presentation was desired. CONCLUSIONS: Participants expressed their desire for a responsive, structured, and clearly focused phone call that would recognise the young person and parent/carer's needs while providing tailored support to ease transition from the ED to available community and family led care.

Do self-reported concussions have cumulative or enduring effects on drivers' anticipation of traffic hazards?

AIM: To investigate the cumulative effect of multiple self-reported concussions and the enduring effect of concussion on drivers' hazard perception ability. It was hypothesized: (1) that individuals reporting multiple previous concussions would be slower to anticipate traffic hazards than individuals reporting either one previous concussion or none; and (2) that individuals reporting a concussion within the past 3 months would be slower to anticipate traffic hazards than individuals reporting either an earlier concussion or no prior concussion. METHOD: Two hundred and eighty-two predominantly young drivers (nconcussed = 68, Mage = 21.57 years, SDage = 6.99 years, 66% female) completed a validated hazard perception test (HPT) and measures of emotional, cognitive, health and driving status. RESULTS: A one-way analysis of variance showed that there was no significant effect of concussion number on HPT response times. Similarly, pairwise comparisons showed no significant differences between the HPT response times of individuals reporting a concussion within the previous 3 months, individuals reporting an earlier concussion and the never concussed group. CONCLUSION: The findings suggest that previous concussions do not adversely affect young drivers' ability to anticipate traffic hazards; however, due to reliance on self-reports of concussion history, further prospective longitudinal research is needed.

Applying heuristic evaluation to observation chart design to improve the detection of patient deterioration.

A key goal for patient safety is to improve the early recognition and management of patients whose conditions deteriorate whilst in hospital. Paper-based observation charts are the main means of recording and monitoring patients' physiological stability, yet observations (e.g., blood pressure, heart rate, and respiratory rate) are not always correctly recorded or appropriately acted upon. No prior published study has applied usability heuristics to systematically compare the usability of multiple observation chart designs. In this study, five evaluators with human factors, applied psychology, or medical expertise inspected 25 observation charts for usability problems. Every chart was found to have substantial usability problems, potentially affecting the ability of hospital staff to accurately record observations or recognize patient deterioration. We proposed a new observation chart design, which avoids many of the previously observed usability problems.

Return-to-driving expectations following mild traumatic brain injury.

AIM: Although individuals recovering from mild traumatic brain injury (MTBI) could pose a risk to road safety, little is known about their intentions regarding return-to-driving. Reported are the expectations of a sample of emergency department patients with MTBI regarding their recovery and return-to-driving. METHOD: Eighty-one patients with MTBI were recruited from an emergency department. Participants completed an 11-item questionnaire measuring expectations regarding recovery from injury; five of the items addressed return-to-driving. RESULTS: Only 48% of the sample intended to reduce their driving following their injury. However, those that did intend to reduce their driving nominated a mean duration of 16.59 days (SD = 31.68) of reduced exposure. A logistic regression found that previous head injury experience and an interaction between pain and previous head injury experience predicted intentions to reduce driving. Similarly, a multiple regression revealed that pain level contributed significantly to the variance in time estimates of return-to-driving. CONCLUSION: The finding that half the individuals recovering from MTBI do not intend to moderate their driving exposure post-injury is cause for concern, as another study has shown that driving performance is compromised in this group immediately after injury.

Designing observation charts to optimize the detection of patient deterioriation: reliance on the subjective preferences of healthcare professionals is not enough.

AIM: Observation charts are critical to detecting patient deterioration. Research suggests their design has a dramatic impact on user performance in terms of failure rates for detecting abnormal vital signs and how quickly users can interpret recorded observations. In this study, we examined the design preferences of professional chart users to assess their alignment with objective performance data. In addition, we tested the assumptions of prior knowledge that chart designers appear to have made about chart users. METHODS: We conducted an online survey of health professionals (n=347). Participants answered questions about their observation chart design preferences in general, and were randomly assigned to evaluate one of nine specific charts. RESULTS: Chart users' preferences for design features were not always consistent with objective performance data. While some views concurred with empirical findings (e.g., participants preferred to plot observations on a graph with graded colouring, where the colours corresponded with degrees of abnormality), others did not (e.g., participants preferred plotting blood pressure and pulse together on the same chart area, which the objective data suggest is problematic). Additionally, a substantial proportion of respondents were unfamiliar with some of the assumed knowledge required to interpret many charts (e.g., particular abbreviations). CONCLUSIONS: It is dangerous to rely solely on subjective opinions - even those of experienced health professionals - when developing patient observation charts, as optimal design may be counterintuitive and some preferences may merely reflect familiarity. Objective performance data is also required. In addition, the level of assumed knowledge required to use a chart should be minimized.

Supporting the detection of patient deterioration: observation chart design affects the recognition of abnormal vital signs.

AIM: To evaluate the effect of observation chart design on the ability of health professionals and novice chart users to recognise patient deterioration. METHODS: Participants were 45 health professionals (doctors and nurses) and 46 novices. Each participant completed 48 trials in which they viewed realistic patient observations recorded on six hospital observation charts of differing design quality. Each chart design was used on eight trials, four times with normal data and four times with abnormal data. On each trial, the participant's task was to identify any abnormal observation or else to indicate that all observations were normal (based on normal physiological ranges given in the instructions). The main outcome measures were participants' error rates and response times for detecting abnormal observations on each of the six charts. RESULTS: There was a significant effect of chart type on error rates (p<0.001), but health professionals made the same number of errors as novices (p=0.43). Chart type also had a significant effect on response times (p<0.001). Health professionals responded faster overall than novices (p=0.006); however, a significant interaction between chart type and participant group (p=0.02) indicated that the health professionals' advantage was confined to the two most rudimentary charts. No significant differences were found between doctors and nurses on either measure. CONCLUSIONS: Our findings suggest that observation chart design has a substantial impact on the decision accuracy and response times of both health professionals and novices in recognising abnormal patient observations.

Assessment of drivers' ability to anticipate traffic hazards after traumatic brain injury.

OBJECTIVES: The aim of this study was to examine the effect of traumatic brain injury (TBI) on drivers' ability to anticipate traffic hazards. Slower anticipation of hazards has been associated with higher crash rates, but this driving skill has never been assessed after TBI. METHODS: The anticipatory ability of 31 drivers with TBI and 24 age-matched uninjured controls was assessed with a validated drivers' Hazard Perception Test. The Hazard Perception Test displayed videos of genuine traffic scenes filmed from the driver's perspective, and participants had to respond as soon as they anticipated a traffic hazard in a scene. The primary dependent measure was mean response latency. RESULTS: Participants with TBI were significantly slower to anticipate traffic hazards than controls (p<0.001). Within the TBI group, while hazard perception response times were significantly related to duration of post-traumatic amnesia (Spearman ρ=0.63; p<0.001), they were not significantly related to Glasgow Coma Scale scores (r=-0.19; p=0.33). Also, participants with a complicated mild TBI were significantly faster in anticipating traffic conflicts than participants with moderate to severe TBI (p=0.04). CONCLUSIONS: Individuals with TBI were slower to anticipate traffic hazards than age-matched uninjured controls. This finding signifies the need for hazard perception testing and training as part of driving rehabilitation after TBI.

Driving after concussion: the acute effect of mild traumatic brain injury on drivers' hazard perception.

OBJECTIVE: No research has examined whether individuals recovering from a recent mild traumatic brain injury (MTBI) are safe to drive, despite cognitive impairment being a common consequence soon after MTBI. This study examined the acute effect of MTBI on drivers' hazard perception, which is defined as drivers' ability to search the road ahead to rapidly identify potentially dangerous traffic situations. Poorer hazard perception has been associated with higher crash rates in a number of studies. METHOD: Forty-two patients with MTBI and 43 patients with minor orthopedic injuries were recruited from the emergency department of a large metropolitan hospital within 24 hours of injury. Participants completed a computerized hazard perception test, in which they watched videos of genuine traffic scenes filmed from the driver's point of view. They were required to use the computer mouse to click on potential traffic hazards as early as possible. RESULTS: Participants with MTBI were significantly slower to respond to traffic hazards than participants with minor orthopedic injuries (p = .03, d = .48). CONCLUSIONS: This study provides the first indication that within the acute stage postinjury, MTBI is associated with impairment in a crash-related component of driving. This suggests that patients with MTBI should be advised to refrain from driving for at least the first 24 hours' postinjury.