ORCID Profile
0000-0002-5406-9279
Current Organisations
Monash University
,
University of Melbourne
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Publisher: Informa UK Limited
Date: 28-11-2015
DOI: 10.3109/13561820.2014.984021
Abstract: The rapid response system (RRS) is a patient safety initiative instituted to enable healthcare professionals to promptly access help when a patient's status deteriorates. Despite patients meeting the criteria, up to one-third of the RRS cases that should be activated are not called, constituting a "missed RRS call". Using a case study approach, 10 focus groups of senior and junior nurses and physicians across four hospitals in Australia were conducted to gain greater insight into the social, professional and cultural factors that mediate the usage of the RRS. Participants' experiences with the RRS were explored from an interprofessional and collective competence perspective. Health professionals' reasons for not activating the RRS included: distinct intraprofessional clinical decision-making pathways a highly hierarchical pathway in nursing, and a more autonomous pathway in medicine and interprofessional communication barriers between nursing and medicine when deciding to make and actually making a RRS call. Participants also characterized the RRS as a work-around tool that is utilized when health professionals encounter problematic interprofessional communication. The results can be conceptualized as a form of collective incompetence that have important implications for the design and implementation of interprofessional patient safety initiatives, such as the RRS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Wiley
Date: 05-2012
DOI: 10.5694/MJA10.11474
Abstract: Simulation-based education (SBE) is a rapidly developing method of supplementing and enhancing the clinical education of medical students. Clinical situations are simulated for teaching and learning purposes, creating opportunities for deliberate practice of new skills without involving real patients. Simulation takes many forms, from simple skills training models to computerised full-body mannequins, so that the needs of learners at each stage of their education can be targeted. Emerging evidence supports the value of simulation as an educational technique to be effective it needs to be integrated into the curriculum in a way that promotes transfer of the skills learnt to clinical practice. Currently, SBE initiatives in Australia are fragmented and depend on local enthusiasts Health Workforce Australia is driving initiatives to develop a more coordinated national approach to optimise the benefits of simulation.
Publisher: BMJ
Date: 23-05-2012
Publisher: SAGE Publications
Date: 09-2016
Abstract: Modern Hospitals are under ever increasing efficiency pressures patient safety and flow are paramount. In the after-hours period, many tasks such as transfers between clinical areas and procedures are delayed because the resources may be limited or poorly distributed compared to in hours. An Electronic Task Management (ETM) system was iteratively designed to support the redesign of the after hours staffing and task distribution model that addressed these delays and improved staff efficiency. The solution consisted of a task controller program installed on desktop PCs in the clinical areas and similar software on smart phones for the clinical staff (operatives) undertaking the clinical tasks. In a system without clinical leadership and workload transparency, the forced reallocation of tasks to operatives was strongly resisted by the operatives. The development of an interface that allowed workloads of all operatives to be visualized by all other operatives led to a socially mediated, cooperative solution that was readily accepted. The quality of the information sent by the ETM was superior to the previous paging system and workloads were more equitable among operatives with the introduction of the ETM.
Publisher: Springer Science and Business Media LLC
Date: 28-01-2017
Publisher: Elsevier BV
Date: 09-2016
Publisher: Wiley
Date: 28-09-2016
DOI: 10.1111/ANAE.13665
Publisher: Wiley
Date: 15-03-2016
DOI: 10.1111/ANAE.13444
Publisher: Wiley
Date: 07-11-2023
DOI: 10.1111/ANAE.15904
Publisher: Wiley
Date: 02-11-2017
DOI: 10.1111/ANAE.13707
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1093/BJA/AEV032
Publisher: SAGE Publications
Date: 09-2016
Abstract: The goal of this research was to examine the decisions made by anesthesia providers in emergency and routine clinical situations relating to airway management. A key function of anesthesia is to ensure oxygen can be delivered to the lungs via a patient’s airway. Failure to maintain adequate oxygen levels leads to brain damage and death. The anesthetic work environment is complex. Occasionally, stressful situations occur when difficulties in airway management arise. Members of the anesthesia team must then engage in complex cognitive activities such as rapid, collaborative decision-making. It is suggested that cognitive aids may support decision-making in these situations, although this has not yet been evaluated empirically from a Cognitive Systems Engineering perspective. This ongoing research combined two studies using Cognitive Task Analysis methods as part of a Decision-Centered Design process: observations and Critical Decision Method interviews. These will inform subsequent research phases concerning the development and evaluation of design concepts.
Publisher: IGI Global
Date: 2012
DOI: 10.4018/978-1-4666-2657-7.CH011
Abstract: In healthcare, medical simulation describes a heterogeneous group of methods that aim to replicate some aspect of clinical care. This chapter discusses the extent to which simulation is being used to explore facets of patient safety from the design of specific devices that are being used in the context of clinical work, to the broader organizational design of systems. The most commonly associated aspect of medical simulation is the education of clinicians in relation to improving patient safety. Few studies have attempted to examine how simulation education can affect patient safety however, there is an emerging body of evidence that simulation training, particularly with regard to the training of teams, can have a positive effect on patient safety outcomes. The barriers commonly incurred with the implementation of simulation training warrant exploration and discussion so that an informed and strategic approach is adopted to allow the future direction of medical simulation in healthcare to be educationally sound and financially sustainable.
Publisher: BMJ
Date: 04-2009
Abstract: Suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety. The use of a structured method of communication has been suggested to improve the quality of information exchange. The aim of this study was to determine if the teaching of a communication tool, ISBAR (Identify, Situation, Background, Assessment, Recommendation), a modification of SBAR (Situation, Background, Assessment, Recommendation), improved the content and clarity of a telephone referral in an immersive simulated clinical scenario conducted in real time. Seventeen teams of final-year medical students were randomised into two groups. The intervention group participated in a 40 min education session about the ISBAR communication tool. A control group received no training. Each team of five students participated in a simulated clinical scenario using a patient simulator in a mocked-up clinical environment. During each scenario, one student made a telephone referral seeking assistance from a senior colleague. Audio data for the telephone referrals (n = 17 students) were captured during the scenario for both groups. During a blinded review of the data, communication was scored on both content and clarity. Communication content was higher from a mean score of 10.2 to 17.4 items (p<0.001) with the intervention. Clarity of the delivery of information on a 5-point scale was also higher in the intervention group (rho = 0.903, p<0.001). The teaching of a structured method of communication improved the communication during telephone referral in a simulated clinical setting. This research has implications for how healthcare professionals are taught to communicate with each other.
Publisher: Springer Science and Business Media LLC
Date: 16-04-2011
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.APERGO.2019.01.005
Abstract: Current decision support interventions for airway management in anaesthesia lack the application of Human Factors Engineering leading to interventions that can be disruptive, inefficient and error-inducing. This study followed a decision-centred design process to identify decision support that can assist anaesthesia teams with challenging airway management situations. Field observations, Critical Decision Method interviews and focus groups were conducted to identify the most difficult decisions and their requirements. Data triangulation narrowed the focus to key decisions related to preparation and planning, and the transitioning between airway techniques during difficulties. Five decision-support interventions were identified and positively rated by anaesthesia team members in relation to their perceived effectiveness. An organized airway equipment trolley was chosen as the most beneficial decision support intervention. This study reiterated the key importance of both Human Factors Engineering and data triangulation when designing for healthcare.
Publisher: Springer Science and Business Media LLC
Date: 08-07-2015
Publisher: Wiley
Date: 16-12-2016
DOI: 10.1111/ANAE.13354
Abstract: There is little doubt that these guidelines incorporate advances made in airway management since 2004. They will change day-to-day practice of anaesthesia, as outlined above, from pre-operative airway assessment, to integrating the WHO team briefing, to the use and provision of equipment and drugs, and the recording of information on the anaesthesia chart. They will inform the later analysis of any critical airway incidents, especially as documentation and postoperative management are addressed, and they will encourage training in a range of techniques. Taken together, not quite a revolution but certainly a very 'radical evolution'.Assessment of the utility of the new guidelines should consider if they can be used as tools to enhance knowledge and training, or in addition as a prosthesis to bridge the gap between the requirements of and our abilities during emergencies. Formal testing may reveal which aspects of their design, complex as it is, may distract from, rather than enhance, airway management during crises.All guidelines represent a standard of care or a normative approach to a clinical problem. As such, they not only help guide clinicians, but they also provide the broader community with the opportunity to improve standards, to ensure equipment is available, and that training for the skills and processes required are in place to ensure successful adoption.
Publisher: Wiley
Date: 21-01-2016
DOI: 10.1111/ANAE.13332
Publisher: Wiley
Date: 05-11-2022
DOI: 10.1111/ANAE.15610
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: Springer International Publishing
Date: 08-08-2019
Publisher: Springer Science and Business Media LLC
Date: 22-12-2016
DOI: 10.1038/JP.2016.235
Abstract: The International Liaison Committee on Resuscitation (ILCOR) provides recommendations on neonatal resuscitation training and practice, which includes a template for a decision-making algorithm. We evaluated the design properties of the ILCOR algorithm and four adaptations by member resuscitation organizations using the validated Cognitive Aids in Medicine Assessment Tool (CMAT). Two experts rated five neonatal resuscitation algorithms against the CMAT and against medical device design criteria. The ILCOR algorithm scored 32 of a possible 60 CMAT points, showing an adherence rate to CMAT of 53%. The ILCOR algorithm scored higher than the design variations by member organizations. Nonetheless, there are design limitations in the ILCOR algorithm. In principle, cognitive aids can improve neonatal resuscitation team performance however, a considered design process that incorporates the full complexity of the 'procedure as performed' is needed to improve future versions of the algorithm for incorporation in international guidelines.
Publisher: Wiley
Date: 11-06-2014
DOI: 10.1111/ANAE.12601
Abstract: Guidelines outlining recommended actions are difficult to implement in the stressful, time-pressured situation of an airway emergency. Cognitive aids such as posters and algorithms improve performance during some anaesthetic emergencies however, their effects on team behaviours have not been determined. In this study, 64 participants were randomly assigned into control (no cognitive aid) and intervention (cognitive aid provided) groups before a simulated 'can't intubate, can't oxygenate' scenario. Video analysis was undertaken of the non-technical skills and technical performance during the scenarios. All categories had higher Anaesthetists' Non-Technical Skills (ANTS) scores when a cognitive aid was supplied (mean (SD) total ANTS score 10.4 (3.1) vs. 13.2 (2.4), p < 0.001). The number of times the cognitive aid was used was associated with higher ANTS scores (ρ = 0.383, p = 0.002). A trend towards the establishment of an infraglottic airway within 3 min was also noted (control group 55.3% vs. intervention 76.9%, p = 0.076). Non-technical skills are improved when a cognitive aid is present during airway emergencies.
Publisher: Wiley
Date: 28-01-2023
DOI: 10.1111/ANAE.15978
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
No related grants have been discovered for Stuart Marshall.