Medical decision making edited
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The document discusses improving medical decision making training for students and residents. It proposes using simulations of common clinical situations to provide deliberate practice under pressure. Research showed trainees with more ICU experience made fewer errors in simulations. "War games" simulations improved performance for all groups to the level of experts after just three sessions. Critical incident interviews revealed experts primarily use recognition-primed decision making while novices rely more on trial and error. Mandatory simulations were proposed to evaluate basic competencies before residents treat patients independently.
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©2022 Chamberlain University. All Rights Reserved.
Revised 9.12.2022 1
Student Instructions for Standardized Simulation
NR341/342 Susan Weil
PURPOSE:
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the simulation as a nurse.
Charge Nurse (1):
The charge nurse is responsible for the overall organization of safe, quality patient care. You are the team leader
and serve as a resource to all interdisciplinary members and are responsible for the appropriate delegation of
duties. You will serve as the point person for communication and can anticipate speaking with the physician or
other primary care provider, ancillary support services, and others directly involved with the care being
provided. You must be knowledgeable about the patient’s condition and able to dictate orders obtained and
assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs.
Medication Nurse (1):
The medication nurse is responsible for all actions and documentation related to the safe administration of
medications. You will identify and correct any medication errors related to prescribing or distribution. This may
include speaking with the physician or primary care provider. Prior to administering medication, you will assure
the “Rights of Medication Administration.” You must be knowledgeable regarding the action and expected effects
of the medications being administered and are responsible for monitoring and reporting any adverse reactions or
unforeseen consequences of administration. Part of your role includes verifying medication calculations with a
colleague and identifying any incompatible drug combinations.
Documentation Nurse (1):
The documentation nurse is responsible for the recording of all patient event activities during the simulation
except for medication administration. You are responsible for documentin.
TeamSTEPPS 2013 Presentation "Create your own simulations and evaluate them"
The document discusses a presentation on using simulations and debriefs to evaluate team performance. Some key points:
- The presentation covered developing TeamSTEPPS training scenarios, using simulations and checklists to evaluate behaviors, and identifying the importance of reflection and psychological safety during debriefs.
- A case study was presented on using simulations to address delays in calling rapid response teams at a hospital. Post-training surveys found that simulations helped build confidence and that new communication techniques would be employed.
- Debriefings after simulations were found to promote self-reflection and identification of barriers to improve performance. Teams that debriefed were shown to perform up to 40% better.
1115 wyatt wheres the science in hi for christchurch nz oct 2015
The document discusses using theory-based research to improve health informatics (HI). It provides examples of testing theories from fields like communication, decision-making, and behavior change to optimize eHealth interventions before randomized controlled trials. Specific theories and studies testing things like how alert formatting impacts prescribing are summarized. The document argues this approach can help establish HI as a professional discipline by building a scientific evidence base for more reliable eHealth tools.
POWERPOINT LECTURE Overview of Risk Management, Root Cause Analysis.pptx
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Course 2 the need for a careful and thorough history
The medical literature reports that 40%-80% of chronic pain patients are misdiagnosed. Clearly, misdiagnosis leads to ordering the wrong tests, and thereby obtaining an incorrect diagnosis, or overlooking a diagnosis totally, which results in mistreatment. Many reports in the medical literature indicate the best way to get an accurate diagnosis, is to obtain a complete and thorough history. However, this is a time consuming process, and most physicians don’t spend the needed time with a patient. Therefore, a team of doctors from Johns Hopkins Hospital developed a 72 question test, with 2008 possible answers, available over the Internet. When a patient completes the questionnaire, diagnoses are returned within 5 minutes. These diagnoses have a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This is the highest level of accuracy of any expert system available. The efficacy of this approach is proven by outcome studies, which prove that this approach results in a far higher return to work rate and reduced use of medication and doctors visits, when compared to other techniques. This is similar to the techniques used by Johns Hopkins Hospital to reduce their workers compensation payments by 54%.
Zasler, Nathan
1) Assessment of effort is important in TBI clinical practice and research to generate valid data on patients' true cognitive capacities, as poor effort is common and can invalidate test results.
2) Formal effort tests should be integrated into evaluations to detect exaggeration and rule out other factors, given the effects of poor effort can dwarf those of mild TBI.
3) Various external incentives like compensation can adversely impact effort, so it is important to consider effort and response bias in clinical and research work involving people with TBI.
Evidence-Based Practice
This randomized controlled trial evaluated the effectiveness of a tailored web- and text-based smoking cessation program called iQuit in Practice compared to usual care among smokers in primary care. The intervention led to significantly higher quit rates at 4 weeks compared to usual care. However, the differences in quit rates were not sustained at 6 months.
The study used a randomized controlled trial design, which is considered the gold standard for evaluating interventions. As a Level I evidence on the hierarchy, this provides the highest level of evidence that the iQuit in Practice program leads to short-
MEU WORKSHOP Clinical Skills Education
This document discusses clinical skills education. It begins by defining skill learning and explaining why emphasis on skills education has increased. It then outlines 12 domains of basic clinical method competencies according to the AAMC Task Force recommendations. These include competencies students bring to medical school, elementary clinical skills, clinical management skills, and providing patient-centered care. The document provides examples of skills teaching and closing tips, emphasizing practice, feedback, and mentoring over lectures. Research shows curricula emphasizing skills education leads to better clinical performance outcomes.
Leonard Plenary ICCH09 PowerPoint
This plenary took place on Tuesday, October 6, at 8:30 am at the International Conference on Communication in Healthcare (ICCH), in Miami Beach, Florida, USA.
The Path to Safe and Reliable Healthcare
Michael Leonard, MD
Michael Leonard, MD, is the Physician Leader for Patient Safety at Kaiser Permanente, a Principal at Pascal Metrics, and a Faculty member at the Institute for Healthcare Improvement (IHI). An Honors graduate of the University of Missouri School of Medicine, Michael did his postgraduate
training in Internal Medicine and Anesthesiology at Harvard’s Beth Israel Hospital in Boston, with fellowship training in cardiac anesthesia. Michael was a practicing anaesthesiologist for 14 years
with the Colorado Permanente Medical Group, where he was Chief of Anesthesia, Chief of Surgical Services, and Chairman of the Board of Directors. In 1999, he helped Kaiser forge a collaborative relationship with Dr. Robert Helmreich’s Human Factors Research Project to work on the application
of human factors teamwork and communication training in medicine.
For the past several years, he has taught extensively throughout the Kaiser system and outside organizations in high-risk areas such as surgery, obstetrics, critical care and others to enhance safety. His relationships with outside organizations include Duke, Baylor, Sloan Kettering, ICSI, Minnesota Children’s, Ascension, Adventist, VHA, Greater New York Hospital Association and
others. At the IHI, he has been active in several domains, including the Patient Safety Officer Training Course, Transforming Care at the Bedside, the Superior Performance Initiative in the United Kingdom, and Patient Safety Scotland.
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The best of_the_pem_literature_in_the_last_year_terry_klassen_presentation
This document summarizes several key pediatric emergency medicine studies from 2012-2013. It discusses 10 topics:
1. A randomized controlled trial compared polyethylene glycol 3350 vs enema for fecal disimpaction, finding no significant differences in symptom improvement between groups at day 5.
2. A clinical practice guideline stratified appendicitis risk into low, medium, and high to guide imaging and surgical referral.
3. Two studies examined diagnostic tools and physician accuracy for diagnosing intussusception.
4. An intervention to improve structured pain management in the pediatric ED led to more patients receiving analgesics faster and more frequent reassessment.
5. Studies found that rest improves concussion symptoms and reductions in
Thesis Defense - Tommy May
The document describes the development of a situational judgment test (SJT) to assess teamwork skills in medical professionals. Key points:
- Existing teamwork assessments have limitations, so the study aimed to create a low-cost SJT. Researchers developed items based on teamwork examples from medical experts.
- The SJT measures five teamwork dimensions: communication, team structure, mutual support, leadership, and environmental awareness. Items were sorted into dimensions and revised for agreement.
- Data was collected from medical students and professionals to validate the SJT. Results showed the SJT differentiated students and professionals better than an existing teamwork measure.
- Further validation is needed, but the SJT shows potential
Assuring quality nursing skills development through practising on a high-fide...
Nursing students practiced on a high-fidelity human patient simulator to develop skills in a risk-free environment. The simulator could blink, have variable pupils and simulated heart/lung/bowel sounds. Students assessed and treated simulated patients with conditions like stroke and burns. They communicated as a team and with family members. Students reported benefits like visualizing physiological effects, handling stress, and reflecting on their actions without risk to patients. The human simulation helped improve critical thinking, communication skills, and handling stress in professional nursing practice through situated learning experiences.
Diagnostic error
The document discusses diagnostic error in emergency departments and how emergency physicians think. It outlines that the ED is prone to error due to factors like uncertainty, time pressure, and high cognitive load. It describes a dual-process theory of thinking, with intuitive and analytical approaches, and how understanding this can help mitigate errors. It provides suggestions for EPs to improve their thinking, such as using aids to reduce reliance on memory and practicing metacognition to take a reflective problem-solving approach.
Teku. Diciembre 2011
The document summarizes a quote from the Dean of Cornell Medical College stating that half of what medical students are taught may be wrong, but it is unknown which half is incorrect. It then provides statistics on the increasing amount of primary literature that general internists would need to read to keep up to date, estimating they would need to read over 30 articles per day today. The final section summarizes a study which found that primary care physicians in Spain are only able to answer about 1 in 5 of the clinical questions that arise during patient consultations due to limited average consultation time of under 10 minutes.
Gpt buchman
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
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Medical decision making edited
- 1. Medical Decision Making Jeffrey Young, MD, FACS Professor of Surgery Director, UVA Trauma Center Chief Quality Officer University of Virginia Health System
- 8. Expertise
- 18. Proactive vs. Reactive: The Effect of Experience on Performance in a Critical Care Simulator Jeffrey S Young, MD, Robert L Smith, MD, Jayme B Stokes, MD and Chadrick E Denlinger, MD Presented, Association for Surgical Education, 2005 Published in the American Journal of Surgery, 193(1): 100-104, 2007.
- 21. Demographics * p<0.05 1Y 4.3±3.9 13.9±2.95* 24±5.7 3 GS, 1 EM 32±4.8 4 Expert (>10 weeks ICU experience) 2Y 5.1±2.0 5.4±3.6* 18.2±8.8 4 GS, 1 EM 28±1.6 5 N-I (0-10 weeks ICU experience) AOA Sleep in past 24 hours ICU Weeks Months of Postgraduate Education Residency Age N Group
- 22. Weeks of ICU Experience * p <0.05 # p =0.07 * p <0.05 # p =0.07 21.8±9.9* 3±2.7 3.2±1.3 0.75±0.96* 19.8±2.2# Expert (>10) 4±2.6* 4±2 3.2±1.6 5.6±3.5* 15.2±3.96# N-I (0-10) Proactive Steps Backward Reasoning Forward Reasoning Cognitive Errors Key Clinical Tasks ICU Weeks
- 23. Months of Residency All comparisons not significant . 9.25±6.4 4±2.9 3.3±0.95 1.75±2.2 17.25±3.9 >24 14±14.5 3.2±1.8 3.2±1.8 4.8±5 17.2±4.4 0-24 Proactive Steps Backward Reasoning Forward Reasoning Cognitive Errors Key Clinical Tasks Months Residency
- 25. War Games
- 28. PERFORMANCE OF STUDENTS AND RESIDENTS IN BASIC CLINICAL SCENARIOS: A DISTURBING ANALYSIS Journal of Trauma, 63(3): 556-564, September, 2007
- 35. USE OF “WAR GAMES” TO ENHANCE HIGH-RISK CLINICAL DECISION MAKING IN RESIDENTS AND STUDENTS American Journal of Surgery, June, 2008
- 48. Lessons learned
- 52. Thank you