Medicine and Health Sciences Commons^™

Tensions Influencing Operating Room Team Function: Does Institutional Context Make A Difference?, Lorelei Lingard, Stacey Garwood, Dan Poenaru

Lorelei Lingard

BACKGROUND: A recent study of operating room (OR) team communication in a large, urban hospital described recurrent tension catalysts and a preliminary theory of team members' interpretive processes. To determine to what extent these findings were transferable to other institutional contexts, we conducted a validation study in 2 small, academic hospitals in a mid-size city. METHODS: Eight focus groups and 8 interviews were conducted with 6 general surgeons, 22 OR nurses, 5 anaesthesiologists and 10 trainees. Observations of 10 surgeons and their team members were conducted over 4 months. Data were analysed by applying thematic codes derived from previous research …

Exploring Obstacles To Proper Timing Of Prophylactic Antibiotics For Surgical Site Infections, J. Tan, V. Naik, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections. METHODS: 27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the …

Evaluation Of A Preoperative Team Briefing: A New Communication Routine Results In Improved Clinical Practice, Lorelei Lingard, Glenn Regehr, Carrie Cartmill, Beverley Orser, Sherry Espin, John Bohnen, Richard Reznick, Ross Baker, Lorne Rotstein, Diane Doran

Lorelei Lingard

Background: Suboptimal communication within healthcare teams can lead to adverse patient outcomes. Team briefings were previously associated with improved communication patterns, and we assessed the impact of briefings on clinical practice. To quantify the impact of the preoperative team briefing on direct patient care, we studied the timing of preoperative antibiotic administration as compared to accepted treatment guidelines.

Study design: A retrospective pre-intervention/post-intervention study design assessed the impact of a checklist-guided preoperative team briefing on prophylactic antibiotic administration timing in surgical cases (N=340 pre-intervention and N=340 post-intervention) across three institutions. χ(2) Analyses were performed to determine whether there was a …

Timing Of Surgical Antibiotic Prophylaxis Administration: Complexities Of Analysis, Carrie Cartmill, Lorelei Lingard, Glenn Regehr, Sherry Espin, John Bohnen, Ross Baker, Lorne Rotstein

Lorelei Lingard

BACKGROUND: The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. CHALLENGES: Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different …

Perceptions Of The Role Of The Registered Nurse In An Urban Interprofessional Academic Family Practice Setting, Jennifer Akeroyd, Ivy Oandasan, Ann Alsaffar, Cynthia Whitehead, Lorelei Lingard

Lorelei Lingard

Registered nurses (RNs) in Ontario have been asked to work collaboratively with family physicians (FPs) and other healthcare professionals in the family practice setting to improve the efficiency and effectiveness of healthcare delivery (OFPN 2005). Yet, little is known about the optimal utilization of the RN's role in family practice. This study builds on recent conversations regarding utilization of the nursing workforce (Oelke et al. 2008) and the nursing role (White et al. 2008) in the acute care setting by presenting perceptions of the role of the RN in an urban academic family practice setting. Interviews were conducted with 23 …

The Impact Of Space And Time On Interprofessional Teamwork In Canadian Primary Health Care Settings: Implications For Health Care Reform, Ivy Oandasan, Lesley Gotlib Conn, Lorelei Lingard, Allia Karim, Difat Jakubovicz, Cynthia Whitehead, Karen-Lee Miller, Natalie Kennie, Scott Reeves

Lorelei Lingard

Aim: This paper explores the impact of space and time on interprofessional teamwork in three primary health care centres and the implications for Canadian and other primary health care reform.

Background: Primary health care reform in Canada has emphasized the creation of interprofessional teams for the delivery of collaborative patient-centred care. This involves the expansion and transformation of existing primary health care centres into interprofessional family health teams (FHT) promising to provide patients better access, more comprehensive care, and improved utilization of individual health professionals. Benefits for providers include improved workplace satisfaction and organizational efficiencies. Currently, there is little evidence …