Quality improvement of integrated child health care management after in-service training for physicians.
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OBJECTIVE: The aim of the present study was to evaluate the quality of integrated child health care management (ICHCM) promoted by the World Health Organization (WHO) after an in-service training course. METHODS: The training was carried out in a rural and an urban health unit and in the paediatric ward of the local reference hospital. Tutorial courses were given to small groups (4-6 students) over a 5-day period (40 h in total). The courses consisted of demonstrations, discussions, analyses, applications and evaluations of the ICHCM (in-service training). The training was evaluated by comparing the quality of ICHCM given by each physician in their work place on three different occasions: 15 days before the course began (pre-course evaluation), 15 days after the course (post-course evaluation) and 6 months after the course had ended (follow-up evaluation). Each physician was observed in each period during his or her consultation with a child under 5 years of age who presented with acute diarrhoea or acute respiratory infection. A series of possible behaviours by physicians was checked against a list of behaviours that would indicate effective training. RESULTS: The average grades obtained by the 24 physicians evaluated (pre- and post-course) increased from 74.5 to 96.6 (22.1 points, P < 0.01). Physicians whose baseline grade was <80 had the greatest increases. Their averages grades increased from 68.2 to 91.3 (23.1 points, P < 0.001). The overall change for the whole group was sustained for up to 6 months (post-course 96.6 points and follow-up 90.9 points, P > 0.05). CONCLUSION: The quality of ICHCM improved after the in-service training. No additional resources were necessary in the clinical units. This type of training can be extended to other countries or health programmes. (+info)
Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.
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OBJECTIVE: To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. STUDY SETTING: Nine teaching and community hospital EDs. STUDY DESIGN: A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. DATA COLLECTION: Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. PRINCIPAL FINDINGS: A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). CONCLUSION: Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals. (+info)
The Zambia quality assurance program: successes and challenges.
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OBJECTIVES: The objectives of the evaluation were to review the performance of the Zambia Quality Assurance Program (ZQAP) and provide recommendations to help design its next phase. DESIGN AND METHODS: Topics for evaluation were identified from a systems analysis of what an 'ideal' quality assurance (QA) program might look like. The evaluation team was made up of six experts who developed questionnaires to guide the interviews and related scoring tools. The evaluation team visited 24 health facilities in nine districts, representing all four regions of Zambia, and interviewed 140 persons, including health personnel from the public and private sectors, and non-health personnel. FINDINGS: In 5 years, senior staff built a QA structure and capacity throughout Zambia, generated enthusiasm for QA, and initiated teamwork on quality of care issues by motivated health staff. Some challenges remain: lack of integration of QA, uncoordinated standards, weak methods of standards communication, poor measurement of compliance with clinical care standards, constraints on the work of the quality improvement teams, and inconsistent support systems. RECOMMENDATIONS: The evaluation team made recommendations regarding a national QA policy, mechanisms to develop standards of care, monitoring of health providers' performance, needs of quality improvement teams, training in QA, and documentation of QA activities. CONCLUSIONS: Despite its success in covering the entire country with a network of QA coaches and trainers, the capacity of the public sector to sustain QA activities at the central and district levels remains a challenge. Lessons from the Zambia experience can benefit QA programs in other developing countries. (+info)
Surgical OGD--a dying art?
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INTRODUCTION: Reductions in surgical training and the increases in medical gastroenterology have raised concerns that surgeons may not be adequately trained in upper gastrointestinal (GI) endoscopy. METHOD: To evaluate this problem, a questionnaire was sent to all current surgical specialist registrars (SpRs) in the South Thames East Region. RESULTS: There was an 82% (52/63) response rate. Only 50% (26/52) of trainees had received more than 6 months' training in upper GI endoscopy. 83% (43/52) were in posts which did not provide adequate elective exposure for training. 50% (26/52) were required to provide an emergency service, despite a paucity of experience and less than 50% were able to perform therapeutic injection. In the main, emergency endoscopy is performed with substandard equipment, poor facilities, and untrained staff. CONCLUSIONS: Surgical trainees are poorly trained and do not have the necessary skills to provide an emergency service for upper GI haemorrhage. Emergency endoscopy facilities are severely under resourced. (+info)
Work-related research, education, and training in developing countries.
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Work-related research, education, and training (WRET) have not been widely recognised in many developing countries (DCs) as the most important factor for sustainable workplace improvement. There are many reasons why WRET is still neglected or remains unrecognised. Empirical research, advanced studies, and training abroad do not seem to be cost-effective for many people living in DCs because of enormous obstacles. Therefore, it is not easy to demonstrate that WRET result in workplace improvement in diverse situations in each DC. Taking into consideration poor health and safety in various workplaces, this paper aims to stimulate critical opinions and discussions on WRET, which are yet to be given high priority in the national agenda to ensure industrial production and social progress. (+info)
Investigation of eye splash and needlestick incidents from an HIV-positive donor on an intensive care unit using root cause analysis.
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BACKGROUND: Two doctors working on a busy intensive care unit sustained injuries whilst removing a chest drain from an HIV-positive patient. One doctor had a needlestick injury into his finger whilst the other sustained an eyesplash when the chest drain was pulled out. METHODS: Following Department of Health format 'Doing less harm', a root cause and human factor analysis of the incident was carried out. The aim was to explore the underlying issues. RESULTS AND CONCLUSIONS: Training, cultural and organizational issues were exposed, and are now being addressed. This approach has led to a far more effective dialogue with the National Health Trust concerned than was previously experienced, and there is early evidence of progress on important aspects of health and safety management at organizational level. Lack of health and safety training of doctors at undergraduate and postgraduate level needs to be addressed. (+info)
Asthma in inner cities.
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While the management of asthma has improved over the past two decades, the incidence of asthma in the inner city has not. The inner city, comprising a disproportionate number of people who live close to or below the poverty line, shows increased rates of morbidity and mortality from asthma. African Americans and Hispanic Americans are two to six times more likely to die from asthma than their white counterparts. When federally funded programs have targeted reducing morbidity and mortality in children from these populations, they have succeeded, but in a national study only 18 states had initiatives targeting asthma in low-income populations. This is tantamount to a public health crisis. Patients are not always properly diagnosed and are often without a regular source of health care, and symptoms are seen only in an acute context. Living conditions for the inner-city child have significant allergen triggers associated with house dust, cockroaches, cigarette smoke, chemical pollutants, and particulate matter. Viral infections, such as those caused by respiratory syncytial virus, are worse in crowded living conditions. The desirability of an increased public awareness of the seriousness of the disease and the need for chronic health care are issues that should be raised, through culturally relevant public means and in the knowledge that visual information is most effective. Physicians must understand the proper use of rescue and controller drugs, and asthma education must expand beyond doctors and nurses in their offices. The National Medical Association is committed to doing this aggressively, and community organizations, alliances, and coalitions must also aggressively follow. Public agencies must be lobbied to set high standards for proper asthma care and resources. With organizations acting in concert, the mortality and morbidity from asthma can be substantially prevented in the inner city. (+info)
Training and supporting pharmacists to supply progestogen-only emergency contraception.
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OBJECTIVE: To describe and evaluate the training and support provided to the first cohort of community pharmacists to supply progestogen-only emergency contraception (POEC) under a Patient Group Direction (PGD) in Lambeth, Southwark and Lewisham, London. DESIGN: The study comprised (a) a systematic analysis of written and oral data from pharmacists before and during training, and at 5 and 13-14 months after launch; (b) analysis of telephone calls to clinical support and (c) analysis of written pharmacy records. SUBJECTS: A total of 20/22 pharmacists in the first training cohort; 6/23 pharmacists who applied but were not accepted were also followed up. RESULTS: A formal course with role-play was a successful training method, and the course also served as a team-building exercise. Subsequent interviews demonstrated that pharmacists had understood the concept of client confidentiality and gained confidence over time in the use of the PGD. The on-call consultants received 152 calls in the first 12 months of the scheme. Over 80% of the calls concerned clinical criteria (notably including 22% that were queries about oral contraceptives). Frequency ranged from one to eight calls per week with 28% made at weekends. In over half (60%) of the calls the pharmacist was subsequently able to make a supply. Queries over client management resulted in several changes in the protocol. The primary expressed concern for all pharmacists at all time points was how clients might 'misuse' or 'abuse' the service, and this remained a concern despite the fact that it also applies to other routes of supply of POEC. However, the PGD cohort was more positive on local benefits than pharmacists who were not selected. CONCLUSIONS: Training and support have enabled this often-underused group of professionals to participate in an extended reproductive health service. Mobile phones are an essential support tool. (+info)