Navigating complexity in team‐based clinical settings

Nov 11, 2018

Authors: Kori A LaDonna, Emily Field, Christopher Watling, Lorelei Lingard, Wael Haddara, Sayra M Cristancho

 

Journal: Medical education
 

Volume: 52
 
Issue: 11
 

Description:

Context

Educators must prepare learners to navigate the complexities of clinical care. Training programmes have, however, traditionally prioritised teaching around the biomedical and the technical, not the socio‐relational or systems issues that create complexity. If we are to transform medical education to meet the demands of 21st century practice, we need to understand how clinicians perceive and respond to complex situations.

Methods

Constructivist grounded theory informed data collection and analysis; during semi‐structured interviews, we used rich pictures to elicit team members’ perspectives about clinical complexity in neurology and in the intensive care unit. We identified themes through constant comparative analysis.

Results

Routine care became complex when the prognosis was unknown, when treatment was either non‐existent or had been exhausted or when being patient and family centred …

The impact of delayed critical care outreach team activation on in-hospital mortality and other patient outcomes: a historical cohort study

Nov 1, 2018

Authors: Bourke W Tillmann, Michelle L Klingel, Shelley L McLeod, Scott Anderson, Wael Haddara, Neil G Parry

 
Journal: Canadian Journal of Anesthesia/Journal canadien d’anesthésie
 

Volume: 65

 

Issue: 11
 

Publisher: Springer US
 

Description:

Purpose

Early warning scores (EWS) and critical care outreach teams (CCOT) have been developed to respond to decompensating patients. Nevertheless, controversy exists around their effectiveness. The primary objective of this study was to determine if a delay of ≥ 60 min between when a patient was identified as meeting EWS criteria and the CCOT was activated impacted in-hospital mortality.

Methods

This was a historical cohort study evaluating all new CCOT activations over a four-year study period (1 June 2007 to 31 August 2011) for inpatients ≥ 18 yr of age at two academic tertiary care hospitals in London, Ontario, Canada. Multivariable logistic regression accounting for repeated measures was used to determine the effect of delayed CCOT activation on in-hospital mortality (primary outcome). Differences in outcomes between medical and …