Browsing by Author "Barach, Paul"

Now showing 1 - 8 of 8
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    Content counts, but context makes the difference in developing expertise: a qualitative study of how residents learn end of shift handoffs
    (BMC, 2018-11-03) Rattray, Nicholas A.; Ebright, Patricia; Flanagan, Mindy E.; Militello, Laura G.; Barach, Paul; Franks, Zamal; Rehman, Shakaib U.; Gordon, Howard S.; Frankel, Richard M.; Anthropology, School of Liberal Arts
    BACKGROUND: Handoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents' perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs. METHODS: A qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts. RESULTS: Although some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients. CONCLUSIONS: Residents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.
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    COVID-19 and Medical Education: A Four-Part Model to Assess Risks, Benefits, and Institutional Obligations During a Global Pandemic
    (Elsevier, 2020-10-23) Barach, Paul; Ahmed, Rami A.; Nadel, Eric S.; Hafferty, Frederic; Philibert, Ingrid; Emergency Medicine, School of Medicine
    The practice of medicine carries inherent risks, especially during outbreaks of highly contagious diseases like Ebola, H1N1, tuberculosis, and COVID-19. Exposure risks remain and extend to medical students and resident/fellows functioning in clinical settings and create ethical dilemmas around service vs. potential risks of illness. At the time of an unprecedented crisis in the US healthcare system, institutional leaders and medical educators are tasked with meeting patient care demands and ensuring the health and well-being of learners across the medical education continuum, while preventing stagnation in their education and promoting their professional growth. In this commentary, we offer a framework to guide medical schools and teaching hospitals leaders’ decisions around the deployment of these learners during the pandemic. To create the framework, we drew on information about minimizing the risks in inherently dangerous industries, practice during earlier outbreaks of dangerous infectious disease and guidance from ethics experts. We provide examples of how this risk framework can be applied to specific situations where medical students and residents/fellows function in a clinical context.
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    Navigating Minority and Gender Discrimination, Substance Use Disorder, Financial Distress, and Workplace Politics: Lessons for Work-Life Wellness in Academic Medicine: Part 2 of 3
    (University of Kansas Libraries, 2023-06-20) Ahmed, Rami; Hartwell, Jennifer L.; Farley, Heather; MacRae, Julia; Rogers, David A.; Lawrence, Elizabeth C.; Brazeau, Chantal Mlr; Park, Eliza M.; Cassidy, Anna; Hartsock, Jane; Holmes, Emily; Schroeder, Kristen; Barach, Paul; Emergency Medicine, School of Medicine
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    Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3
    (University of Kansas Libraries, 2023-06-20) Barach, Paul; Ahmed, Rami; Agarwal, Gaurava; Olson, Kristine; Welch, Julie; Chernoby, Kimberly; Hein, Christine L.; Anand, Tanya; Joseph, Bellal; Rosenstein, Donald L.; Sotto-Santiago, Sylk; Hartsock, Jane; Holmes, Emily; Schroeder, Kristen; Hartwell, Jennifer L.; Medicine, School of Medicine
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    Navigating Work-Life Integration, Legal Issues, Patient Safety: Lessons for Work-Life Wellness in Academic Medicine: Part 1 of 3
    (University of Kansas Libraries, 2023-06-20) Hartwell, Jennifer L.; Barach, Paul; Gunter, Tracy D.; Reed, Kyra; Kelker, Heather; Welch, Julie; Olson, Kristine; Harry, Elizabeth; Meltzer-Brody, Samantha; Quinn, Mariah; Ferrand, Jennifer; Kiely, Sharon C.; Hartsock, Jane; Holmes, Emily; Schroeder, Kristin; Ahmed, Rami; Psychiatry, School of Medicine
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    Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self-Contamination During Donning and Doffing
    (Elsevier, 2022) Doos, Devin; Barach, Paul; Sarmiento, Elisa; Ahmed, Rami; Emergency Medicine, School of Medicine
    Background: At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. Objective: The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. Methods: The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. Results: All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. Conclusions: The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.
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    Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self‐Contamination During Donning and Doffing
    (Elsevier, 2022-03) Doos, Devin; Barach, Paul; Sarmiento, Elisa; Ahmed, Rami; Emergency Medicine, School of Medicine
    Background At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. Objective The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. Methods The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. Results All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. Conclusions The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.
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    Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care
    (Wolters Kluwer, 2021) Wong, Ambrose H.; Ahmed, Rami A.; Ray, Jessica M.; Khan, Humera; Hughes, Patrick G.; McCoy, Christopher Eric; Auerbach, Marc A.; Barach, Paul; Emergency Medicine, School of Medicine
    The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.