Browsing by Subject "Personal Satisfaction"
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Item Standardizing the Intra-Operative Handover Between Faculty Anesthesiologists Using an EMR-Based Tool(2018-03-29) Sheng, Jim Zhengji; Reed, W. Gary; Bryson, Trenton; Greilich, PhilipSHORT DESCRIPTION: The primary aim of this project is to improve faculty satisfaction with a newly implemented intra-operative handoff tool. The secondary aim is to increase the effectiveness of the intra-operative handoffs by creating a user-friendly electronic medical record (EMR)-based cognitive aid designed to improve the reliability of this process. BACKGROUND: Communication failures during intra-operative handoffs can lead to adverse events and poor patient outcomes [1]. Faculty anesthesiologists frequently perform intra-operative handoffs as a part of their patient care responsibilities. While handoffs have garnered international attention calling for standardization [2,3], there are currently few specific recommendations on how intra-operative handoff should be completed. Checklists in the electronic medical record (EMR) have been shown to be effective in improving relay and retention of critical patient information during intra-operative transfers of care [3]. However, the essential elements and qualities in an intra-operative handoff tool have not been explored. This project identified the attributes in an EMR-based intra-operative handoff tool that are critical to faculty anesthesiologists at UT Southwestern Medical Center (UTSW). METHODS: Faculty anesthesiologists were interviewed for thoughts and comments about the current intra-operative handoff tool implemented at UTSW. Qualitative interview responses were separated into unique comments and analyzed for common themes. Quantitative results on opinions about current process handoff process and tool were determined. Critical-to-quality elements for effective intra-operative handoff tool were extracted from interview responses. EVALUATION AND OUTCOMES: Faculty had mixed opinions about current intra-operative handoff process, and most were unsatisfied about current handoff tool. From one-on-one interviews to explore faculty opinion, a total of 80 unique comments were generated regarding the tool, and 4 main themes were identified: patient information, tool functionality, data organization, and implementation. A total of 17 subtopics were identified based on comments. 15 critical-to-quality in an intra-operative tool was identified. IMPACT AND LESSONS LEARNED: Detailed faculty opinion and feedback regarding current intra-operative handoff process and tool at our institution were collected. Key critical-to-quality elements for an effective intra-operative handoff tool were identified and a proposed tool was created based on feedback. Further work will focus on working with electronic medical record system to develop updated and "ideal" tool based on results of this study. REFERENCES: 1. Commission, J. & Others. Improving America's hospitals: The Joint Commission's annual report on quality and safety. The Joint Commission, Oakbrook Terrace (2007). 2. The Joint Commision. "Sentinel Event Alert 58:Inadequate Hand-off Communication." Jointcommission.org, 11 Sept. 2017, www.jointcommission.org/sentinel_event_alert_58_inadequate_handoff_communications/, Accessed March 8, 2018. 3. World Health Organization Collaborating Center for Patient Safety: Communication during Patient Handovers. Geneva, Switzerland, WHO Press; 2007. Available at: http://www.who.int/patientsafety/solutions/high5s/High5_overview.pdf 4. Agarwala, Aalok V., et al. "An Electronic Checklist Improves Transfer and Retention of Critical Information at Intraoperative Handoff of Care." Anesthesia & Analgesia, vol. 120, no. 1, 2015, pp. 96-104., doi:10.1213/ane.0000000000000506.Item Transplant as a Medical Trauma: Posttraumatic Stress Symptoms in Pediatric Solid Organ Transplant Patients, a Mixed Methods Approach(August 2021) Masood, Saba Saleem; Triplett, Kelli; Schuster, Lisa; Lippe, Ben; Killian, Michael; Desai, Dev; Stewart, Sunita M.Posttraumatic stress symptoms (PTSS) have been reported by pediatric solid organ transplant (SOT) patients well after transplantation. Despite the elevated levels of PTSS in this population, subjective factors associated with PTSS and patients' perception of transplant as traumatic and symptom manifestation of PTSS remains unclear. This study aimed to examine the prevalence of PTSS in pediatric SOT utilizing the DSM-5 PTSD criteria and compare the rate to existing rates in pediatric populations, assess variables associated with PTSS, and explore patients' perception of trauma in SOT and clinical presentation of PTSS. Forty patients participated in the study with twenty-six completing qualitative interviews. One participant (2.5%) met criteria for PTSD with a slightly larger proportion (n=5;12.5%) being characterized as "partial PTSD likely." Clinical elevated symptoms of hyperarousal were most commonly endorsed. The majority of the sample endorsed functional impairment/distress associated with the PTSS. Patients with lifetime trauma exposure and a post-transplant psychiatric diagnosis reported significantly higher PTSS. Greater perceived life threat, treatment intensity, and maladaptive coping strategies were associated with higher PTSS. Post-transplant medical complications was associated with lower post-transplant PTSS. Lastly, patients described various aspects of SOT as traumatic with symptoms being pervasive across life domains. Results indicate subclinical levels of PTSS are prevalent in pediatric SOT patients with some experiencing clinically elevated PTSS. Patients with a post-transplant comorbid psychiatric diagnosis are at-risk and would benefit from transdiagnostic assessment and intervention to address symptoms overlapping across disorders. Post-transplant subjective variables and maladaptive coping strategies appear to be an important component to assess, as it relates to PTSS. Objective variables, such as frequent hospitalizations, may be less suggestive of post-transplant PTSS. In-depth examination of the SOT experience and presentation of PTSS via qualitative methods provides insight into how disruption in adolescents' developmental trajectory due to medical trauma is experienced and manifested.