Breaking Bad News: the TAKE five program
VAN CAUWENBERGE, Isabelle ; GILLET, Aline ; Bragard, Isabelle 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 ▲]Detailed reference viewed: 44 (2 ULg)
Gestion des flux patients et surpopulation des urgences : Heurs et malheurs de la fonction de « Bed Manager ».
GILLET, Aline ; Minder, Anaïs ; Nyssen, Anne-Sophie 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 ▲]Detailed reference viewed: 106 (10 ULg)
Emergency department bed coordination: burden and pitfalls.
GILLET, Aline ; Minder, Anaïs ; Nyssen, Anne-Sophie 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 ▲]Detailed reference viewed: 63 (15 ULg)
Stress and distress: The art and science of dispatcher’s assisted cardiopulmonary resuscitation
Zandona, Régine ; GILLET, Aline ; Stassart, Céline 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 ▲]Detailed reference viewed: 19 (4 ULg)
Cognitive support for a better handoff: does it improve the quality of medical communication at shift change in an emergency department?
Gillet, Aline ; GHUYSEN, Alexandre ; BONHOMME, Suzanne 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 ▲]Detailed reference viewed: 115 (36 ULg)
Work incapacity and chronic pain patients: Is there an impact of work incapacity on anxiety and depression?
; Vanootighem, Valentine ; Gillet, Aline et al
Poster (2015, May 28)
In 2011, a report of the Federal Public Service have shown that 8.5% of the Belgian population suffers from chronic pains, which represents 938 300 belgian people (Berquin et al., 2011). These persistent ... [more ▼]
In 2011, a report of the Federal Public Service have shown that 8.5% of the Belgian population suffers from chronic pains, which represents 938 300 belgian people (Berquin et al., 2011). These persistent pains may result in functional limitations on both domestic and professional domains which may lead to temporary or permanently work incapacity (Faymonville et al., 2014). These incapacities may in turn cause a social withdrawal and a tendency to focus on pain (Berquin et al., 2011). Additionally, patients are prone to emotional modifications due to persistent pain (Ossipov et al., 2010). All of these factors may contribute in the emergence of anxiety and depressive symptoms. The present study examines the impact of type of work incapacities (at work, temporary incapacity and permanent incapacity) on anxiety and depression scores as a function of diagnoses (fibromyalgia, chronic pain syndrome, back pain, polyalgia). 123 patients suffering from chronic pain completed a measure of anxiety and depression (HADS), and a self-reported questionnaire of psychological and physical disability at work. We did not found any significant effect of type of work incapacities on anxiety and depression scores. Results present tables of frequencies to illustrate the social and professional situations of patients as a function of chronic pain diagnoses. [less ▲]Detailed reference viewed: 93 (6 ULg)
Efficacy and cost-effectiveness: A study of different treatment approaches in a tertiary pain centre
VANHAUDENHUYSE, Audrey ; Gillet, Aline ; MALAISE, Nicole et al
in European Journal of Pain (London, England) (2015)Detailed reference viewed: 90 (17 ULg)
Effects of sleepiness on emergency physicians’ technical and non-technical skills
Gillet, Aline ; Nyssen, Anne-Sophie ; et al
Conference (2014, February 25)Detailed reference viewed: 36 (7 ULg)
Medical communication at shift change and human error: Could a cognitive support make health care safer?
Gillet, Aline ; Ghuysen, Alexandre ; D'Orio, Vincenzo et al
Conference (2013, May 24)Detailed reference viewed: 87 (8 ULg)
Systèmes de retour d'expérience : "Faut-il vraiment copier l'industrie?"
Nyssen, Anne-Sophie ; Gillet, Aline ; et al
in Risques & Qualité (2012), IX(2), 85-91Detailed reference viewed: 94 (18 ULg)
Emergency physicians’ communication: What about a standardized handover?
Gillet, Aline ; D'ORIO, Vincenzo ; Nyssen, Anne-Sophie
Poster (2011, May 27)
In health care organizations, the need for 24-hour care increases the number of patient’s transfer. Handover and shift changes are now recognized as particularly critical moments for the reliability of ... [more ▼]
In health care organizations, the need for 24-hour care increases the number of patient’s transfer. Handover and shift changes are now recognized as particularly critical moments for the reliability of care. However, few studies focused specifically on how physicians share relevant information during these moments. Moreover, emergency departments are known to be extremely vulnerable to error, because of high time pressure, frequent interruptions, high variability and number of patients, etc. Our study aimed to estimate how emergency physicians share information about a patient during handover, and to evaluate the impact of a procedure of medical handover standardization. To do this, we conducted a pre-post test on completeness of transmissions. We first performed observations of 50 physicians’ shift changes in an emergency department. All of these were video-recorded and then analyzed. We classified communications into seven categories (identifying information, current pathology, patient’s current status, significant patient’s tests results, priority medical interventions, diagnose and recommendations, and dispositions). After these observations, we elaborated and implemented a standardization procedure, according to literature, analyses of our observations and physicians’ recommendations. We finally assessed this procedure by observing and analyzing 40 handovers, using the same method as previously described. We also evaluated the physician’s opinion about the quality of the transmission with a 7-point Likert scale. Our results showed three significant differences before and after the standardization of communications. Physicians share more information about patient’s tests results, priority interventions and dispositions. Moreover, we found a significant difference of the perceived quality of the standardized handover. [less ▲]Detailed reference viewed: 70 (14 ULg)