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See detailBreaking Bad News: the TAKE five program
VAN CAUWENBERGE, Isabelle ULg; GILLET, Aline ULg; Bragard, Isabelle ULg et al

Conference (2017, January 14)

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to ... [more ▼]

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to help physicians delivering such news, many protocols, like SPIKES, BREAKS or SHARE, have emerged worldwide. However, training to such protocol might be time-consuming and not suitable with junior doctors or trainees’ turnover. We hypothesised that a standardized 5-hours training program could improve bad news delivery practice. Participants and methods This preliminary study was conducted in the ED of a tertiary care academic hospital accounting for 90000 ED census per year, 16 attending physicians, 10 junior residents, and 5 trainees per month. Data were collected between November 2015 and April 2016. The study included 3 phases over 4 weeks. Video recorded single role-playing sessions happened the 1st (T1) and the 4th (T3) weeks. A 3-hour theory lesson happened the second week (T2), introducing the basics of therapeutic communication and delivering bad news. Each role-playing session lasted almost 1 hour (10 minutes briefing and medical case reading, 10 minutes role-plays and 40 minutes group debriefing). Bad news delivery performance was evaluated by a 14-points retrospective assessment tool (1). We collected data about the status and impact of a stressful event at 3-days using the French version of the IES-R scale (2). We applied Student t-tests for statistical analysis. Results 14 volunteers (10 trainees and 4 junior emergency physicians) were included in the study. On average, bad-news delivery process took 9’45’’ at T1 and 10’20’’ at T3. From T1 to T3, bad-news delivery performance increased significantly for both junior emergency physicians and trainees (p=0.0003 and p=0.0006, respectively). Further analysis revealed that most relevant increases involved the “situation” (p<0.001), “presentation” (p=0.009), “knowledge” (p=0.037), “emotions” (p=0.01) and “summary” (p=0.001) steps. We also found a significant decrease of the impact of bad-news delivery on trainee physicians’ stress (p=0.006). Discussion and conclusion These preliminary results indicate some potential for this new standardized course of bad news delivery. Apart from allowing physicians increase their communications skills, we believe that this simple 5-hour simulation-training program could alleviate physicians’ stress when they happen to break bad news. References 1. Brunet, A. et al. (2003). Validation of a French version of the Impact of Event Scale-Revised. Can J Psychiatry, 48(1), 56-61. 2. Park, I. et al. (2010). Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock, 3(4), 385-388. [less ▲]

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See detailBreaking Bad News: the TAKE five program.
GILLET, Aline ULg; VAN CAUWENBERGE, Isabelle ULg; TUBES, Rebecca ULg et al

Poster (2016, October)

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See detailProofing & Reduction Strategies Used by Emergency Residents to Manage Fatigue-related Risk
Berastegui, Pierre ULg; Ghuysen, Alexandre ULg; Nyssen, Anne-Sophie ULg

Poster (2016, July 29)

Fatigue and sleep loss are typically associated with psychomotor and cognitive impairment resulting in poorer task performance. Most of these studies are conducted in controlled settings and involve the ... [more ▼]

Fatigue and sleep loss are typically associated with psychomotor and cognitive impairment resulting in poorer task performance. Most of these studies are conducted in controlled settings and involve the completion of experimental tasks. Only a few field studies involving exhausted residents have been conducted over the past decade, and they yielded to contradictory results (Ellman et al., 2004). One of the key factors that could be involved in the non-linear relationship between fatigue and performance in specific work context reside in the mobilization of Fatigue Proofing Strategies. FPS are adaptive and protective risk-reduction behaviors that improve the resilience of a system of work (Dawson et al., 2012). In this study, we aimed to identify and classify proofing strategies mobilized by EMS residents using an inductive content analysis approach. EMS residents reported a range of strategies for reducing subjective level of sleepiness (reduction strategies, n=15) or managing its consequences (proofing strategies, n=17). Content analysis yielded to three sub-categories of proofing strategies: Behavioral Compensation (n=8), Error’s Opportunity Reduction (n=5) and Error’s Consequences Mitigation (n=4). Our results show that EMS residents use both types of strategies although none of the proofing strategies were part of their training program. Despite the current informal use, there is significant potential for implementation of more formal processes. [less ▲]

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See detailGestion des flux patients et surpopulation des urgences : Heurs et malheurs de la fonction de « Bed Manager ».
GILLET, Aline ULg; Minder, Anaïs ULg; Nyssen, Anne-Sophie ULg et al

Conference (2016, July 11)

For many years, emergency departments (ED) overcrowding has become a major issue in Public Health. Many studies have demonstrated the efficiency of flow management coordination on this recurrent problem ... [more ▼]

For many years, emergency departments (ED) overcrowding has become a major issue in Public Health. Many studies have demonstrated the efficiency of flow management coordination on this recurrent problem, by offering an interface between the ED, the hospital and out-of-hospital structures and by coordinating patients’ movements towards hospital care units. This was the basis for the implementation of "bed management" coordination program in the ED of the University Hospital of Liège in January 2014. The present study evaluates the adequacy of the Bed Manager (BM) activity with actual ED and hospital workload. Our results describe the rate of intra-hospital patients’ transfers according to the adequacy of the destination unit and time delays for these transfers. Head nurses from specific care units were interrogated about their perceptions of BM activity. We are now convinced by the importance of a participative approach in the development of ED bed management and working procedures, as well as the usefulness of further studies to explore this complex activity. [less ▲]

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See detailWhy is this urine turning blue? A uncommon alarm but a common disease.
LU, Marie Anh-Dao ULg; GENSBURGER, Mathieu ULg; TONGLET, Martin ULg et al

Poster (2016, January 30)

Turning purple-blue urine is an alarming phenomenon uncommonly seen in patients with chronic urinary catheterization. Such discoloration, often misdiagnosed as haematuria, frequently causes concerns for ... [more ▼]

Turning purple-blue urine is an alarming phenomenon uncommonly seen in patients with chronic urinary catheterization. Such discoloration, often misdiagnosed as haematuria, frequently causes concerns for the nurses, the doctor, the patient and his family. [less ▲]

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See detailEmergency department bed coordination: burden and pitfalls.
GILLET, Aline ULg; Minder, Anaïs ULg; Nyssen, Anne-Sophie ULg et al

Conference (2016, January 30)

Introduction Improving patient flow from emergency department (ED) to in-hospital bed admission has become an everyday challenge. Implementation of an ED bed manager (BM) who monitors hospital beds ... [more ▼]

Introduction Improving patient flow from emergency department (ED) to in-hospital bed admission has become an everyday challenge. Implementation of an ED bed manager (BM) who monitors hospital beds availability daily has been advocated to reduce boarding time for admitted patient. However, little is known on the actual burden and pitfalls of ED bed coordination. Indeed, overcrowded hospitals often lead to inappropriate transfer from ED to less adapted hospital unit or unit with lower level of care. We design the present study to evaluate the occurrence of such step-down units transfer. Methods This prospective study was conducted in a tertiary care academic hospital accounting for 622 licensed beds and an ED census of 45000/year. In 2014, a BM was implemented as a result of a quality improvement program. Focus was made solely on facilitating and improving patient movements form ED to the hospital wards. The investigators extracted data from a 20-days random observation period in February and March 2015, or a total of 231 patients administered by the BM. Results During this period, mean ED census was 131 (±12) patients /day, of which mean hospital admission rate was 20,6 %. BM administered 12 (±3) of these patients daily. Most of these patients were transferred to an appropriate unit (47.6 %) or a short stay unit (32.1%), while 17.7 % were referred to under adapted units and 2.6 % to step down units. Patients’ average length of stay (LOS) was 32 hours. LOS for patients immediately admitted in the ED short stay unit (n=74) was 26.5 (±22) hours, while it took 35.8 (±26) hours to reach an appropriate unit (n=110) and 35.6 (±27.4) to reach a less-appropriate unit (n=41). Interestingly, patients transferred to a non-appropriate unit (n=6) stayed 29.5 (±15.7) hours in the ED. Communications means used by the BM was face-to-face talk almost half of the cases (n=93) and phone calls for the other half (n=115). Discussion and conclusion These results emphasize the complexity of ED flow coordination. Whether or not such coordination is effective on ED overcrowding or patients’ LOS, this preliminary study identifies the frequent use of short stay and under-adapted units instead of optimal bed location. Besides, further research should clarify the impact of these hospitalisations’ pathways on the quality of care. Finally, these observations indicate the urgent need for early determination of patients who could actually be safely transferred to such units. [less ▲]

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See detailApport de l'échographie thoracique aux urgences : à propos d'un cas de dyspnée aiguë durant la grossesse
MARISSIAUX, Laurent ULg; GENSBURGER, Mathieu ULg; TROMBA, A et al

in Revue Médicale de Liège (2016), 71(7-8), 349-355

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See detailDiagnostic de l'hyperémèse cannabinoïde : le point sur le syndrome "cannabis-douche"
CUPPENS, Benoit ULg; GENSBURGER, Mathieu ULg; TONGLET, Martin ULg et al

in Revue Médicale de Liège (2016), 71(12), 541-545

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See detailStress and distress: The art and science of dispatcher’s assisted cardiopulmonary resuscitation
Zandona, Régine ULg; GILLET, Aline ULg; Stassart, Céline ULg et al

in Internal Medicine Review (2016), 2(8),

Chances of survival following a cardiac arrest are very low and inversely proportional to the duration of cardiovascular arrest. It is of critical importance to perform cardiopulmonary resuscitation (CPR ... [more ▼]

Chances of survival following a cardiac arrest are very low and inversely proportional to the duration of cardiovascular arrest. It is of critical importance to perform cardiopulmonary resuscitation (CPR) as soon as possible, even before the arrival of emergency medical team (EMT) on the scene. Therefore, early bystander CPR is a key factor in improving survival from out-of-hospital cardiac arrest (OOH-CA). In Belgium, the ALERT algorithm (Algorithme Liégeois d’Encadrement à la Réanimation par Téléphonea offers the opportunity to help bystanders perform CPR. Dispatchers’ assisted telephone CPR has introduced a new link in the chain of survival, that contributes to a reduced OOH-CA mortality rate but at the cost of increased responsibilities and stress. ALERT also gives a new role to bystanders; they are no longer just spectators but become actors when they witness a cardiac arrest. Our team was interested in the psychological burden of ALERT. Therefore, we evaluated the effects of CPR performed by untrained persons. We studied the potential influence of different coping strategies on this impact, as well as the possible correlation with the degree of attachment to the victim and the risk of developing PTSD (Post Traumatic Stress Disorder). We noticed that some psychological negative impact on the bystanders could be recognized. We also identified beneficial and detrimental coping strategies. In the future, we wonder if Video-CPR (V-CPR) might improve the quality of resuscitation. [less ▲]

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See detailCognitive support for a better handoff: does it improve the quality of medical communication at shift change in an emergency department?
Gillet, Aline ULg; GHUYSEN, Alexandre ULg; BONHOMME, Suzanne ULg et al

in European Journal of Emergency Medicine (2015), 22(3), 192-198

AIM: To improve the communication during shift handover in an emergency department. METHODS: We observed the handover process and analysed the discourse between physicians at shift change first, and then ... [more ▼]

AIM: To improve the communication during shift handover in an emergency department. METHODS: We observed the handover process and analysed the discourse between physicians at shift change first, and then we created two cognitive tools and tested their clinical impact on the field. We used different measures to evaluate this impact on the health care process including the frequency and type of information content communicated between physicians, duration of the handoff, physician self-evaluation of the quality of the handoff and a posthandover study of patient handling. RESULTS: Our results showed that the patient's medical history, significant test results, recommendations (treatment plan) and patient follow-up were communicated to a greater extent when the tools are used. We also found that physicians spent more time at the bedside and less time consulting medical records using these tools. CONCLUSION: The present study showed how in-depth observations and analyses of real work processes can be used to better support the quality of patient care. [less ▲]

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